Provider Demographics
NPI:1316253123
Name:SRIVASTAVA, SWATI (MD)
Entity type:Individual
Prefix:DR
First Name:SWATI
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SAND PIT RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4005
Mailing Address - Country:US
Mailing Address - Phone:203-749-5700
Mailing Address - Fax:203-830-8088
Practice Address - Street 1:79 SAND PIT RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4005
Practice Address - Country:US
Practice Address - Phone:203-749-5700
Practice Address - Fax:203-830-8088
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102847399Medicaid
PA312091Medicare PIN