Healthcare Provider Details

I. General information

NPI: 1023954203
Provider Name (Legal Business Name): KAVYA SRINIVASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CEDAR ST
NEW HAVEN CT
06510-3218
US

IV. Provider business mailing address

330 CEDAR ST LMP 5039
NEW HAVEN CT
06510-3218
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-3898
  • Fax: 203-737-4810
Mailing address:
  • Phone: 203-785-3898
  • Fax: 203-737-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: