Provider Demographics
NPI:1699282723
Name:SIVANESAN, SINTHU (QMHS)
Entity type:Individual
Prefix:
First Name:SINTHU
Middle Name:
Last Name:SIVANESAN
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:MISS
Other - First Name:SINTHU
Other - Middle Name:
Other - Last Name:SIVANESAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5316 AMBROSIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5536
Mailing Address - Country:US
Mailing Address - Phone:614-421-8936
Mailing Address - Fax:
Practice Address - Street 1:5665 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9122
Practice Address - Country:US
Practice Address - Phone:614-421-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator