Healthcare Provider Details

I. General information

NPI: 1639246531
Provider Name (Legal Business Name): BAMA SRIDHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 400
FREMONT CA
94538-1730
US

IV. Provider business mailing address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax: 510-770-8141
Mailing address:
  • Phone: 510-770-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA40677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: