Healthcare Provider Details

I. General information

NPI: 1699657957
Provider Name (Legal Business Name): SREEKANTHAN SUNDARARAGHAVAN MBBS, DCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740, S LIMESTONE SECOND FLOOR WIND D ROOM L203
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

3417 BURCH AVE
CINCINNATI OH
45208-2003
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6754
  • Fax: 859-323-3499
Mailing address:
  • Phone: 859-323-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberTP680
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.077143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: