Healthcare Provider Details

I. General information

NPI: 1508018003
Provider Name (Legal Business Name): NEEHARIKA SRIVASTAVA MAKANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEEHARIKA SRIVASTAVA MD

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 09/03/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W BAY DR STE G
LARGO FL
33770-2245
US

IV. Provider business mailing address

5000 PARK ST N STE 1017
ST PETERSBURG FL
33709-2236
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7780
  • Fax: 863-603-4752
Mailing address:
  • Phone: 727-344-6570
  • Fax: 727-384-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME125481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: