Healthcare Provider Details

I. General information

NPI: 1679956973
Provider Name (Legal Business Name): PRIYANKA SRIVASTAV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 EASTCHESTER DR STE 200
HIGH POINT NC
27265-3116
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-481-8610
  • Fax: 336-481-8619
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1202949
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26045
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: