Provider Demographics
NPI:1417199431
Name:SRINIVASAN, SHIVA PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVA PRAKASH
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25A GARDEN VILLAGE DR
Mailing Address - Street 2:APT # 3
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3375
Mailing Address - Country:US
Mailing Address - Phone:267-809-5034
Mailing Address - Fax:
Practice Address - Street 1:25A GARDEN VILLAGE DR
Practice Address - Street 2:APT # 3
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3375
Practice Address - Country:US
Practice Address - Phone:267-809-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program