Provider Demographics
NPI:1588876445
Name:SRIVASTAVA, SWEETY AJAY (MD)
Entity type:Individual
Prefix:
First Name:SWEETY
Middle Name:AJAY
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 1:3020 S GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1420
Mailing Address - Country:US
Mailing Address - Phone:810-744-3321
Mailing Address - Fax:
Practice Address - Street 1:3020 S GENESEE RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1420
Practice Address - Country:US
Practice Address - Phone:810-744-3321
Practice Address - Fax:810-744-2850
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010890922080P0210X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382406558OtherHAMILTON TAX ID
0-609-209-2OtherECFMG
MI5175322Medicaid
MI0B56065031Medicare PIN