Provider Demographics
NPI:1578212494
Name:DASYAM, ABHINAV
Entity type:Individual
Prefix:
First Name:ABHINAV
Middle Name:
Last Name:DASYAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-6306
Mailing Address - Country:US
Mailing Address - Phone:480-522-7410
Mailing Address - Fax:229-389-2218
Practice Address - Street 1:113 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-6306
Practice Address - Country:US
Practice Address - Phone:480-522-7410
Practice Address - Fax:229-389-2218
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-206282106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician