Healthcare Provider Details

I. General information

NPI: 1396678272
Provider Name (Legal Business Name): RAMYA SREE RAVOLKOL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LN FL 3
LARGO MD
20774-5374
US

IV. Provider business mailing address

1221 MERCANTILE LN FL 3
LARGO MD
20774-5374
US

V. Phone/Fax

Practice location:
  • Phone: 240-678-9813
  • Fax:
Mailing address:
  • Phone: 240-678-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberXXXXXXXXXXXX
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: