Provider Demographics
NPI:1215786660
Name:SREENIVASAN, AISHWARYA
Entity type:Individual
Prefix:
First Name:AISHWARYA
Middle Name:
Last Name:SREENIVASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RICH ST
Mailing Address - Street 2:WALTHAM
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:475-261-8523
Mailing Address - Fax:
Practice Address - Street 1:340 MAPLE ST FL 4
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2494
Practice Address - Country:US
Practice Address - Phone:508-485-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator