Provider Demographics
NPI:1528849882
Name:TENJERLA, SRISAI SARATDYUTI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SRISAI
Middle Name:SARATDYUTI
Last Name:TENJERLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2635 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4802
Practice Address - Country:US
Practice Address - Phone:336-867-4310
Practice Address - Fax:336-867-4311
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-13813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant