Healthcare Provider Details

I. General information

NPI: 1679914089
Provider Name (Legal Business Name): SREE VALLI APARNA SRISHTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH STE G320
MARION IN
46952-2779
US

IV. Provider business mailing address

330 N WABASH STE G20
MARION IN
46952-2600
US

V. Phone/Fax

Practice location:
  • Phone: 765-660-7660
  • Fax: 765-671-3502
Mailing address:
  • Phone: 765-660-7600
  • Fax: 765-651-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01076869A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: