Healthcare Provider Details

I. General information

NPI: 1881089118
Provider Name (Legal Business Name): ANISHA PATEL SRINIVASAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 11/18/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 50TH ST
SACRAMENTO CA
95817-2310
US

IV. Provider business mailing address

2825 50TH ST
SACRAMENTO CA
95817-2310
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-0235
  • Fax:
Mailing address:
  • Phone: 916-703-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA182972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: