Healthcare Provider Details

I. General information

NPI: 1669469862
Provider Name (Legal Business Name): LEELA SRIDHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 N KENDALL DR #104
MIAMI FL
33156-7706
US

IV. Provider business mailing address

7400 N KENDALL DR #104
MIAMI FL
33156-7706
US

V. Phone/Fax

Practice location:
  • Phone: 305-670-5020
  • Fax:
Mailing address:
  • Phone: 305-670-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 42877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: