Healthcare Provider Details

I. General information

NPI: 1164590550
Provider Name (Legal Business Name): SRIDEVI PINNAMANENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 EAST 149 STREET
BRONX NY
10451
US

IV. Provider business mailing address

10 YUKON COURT
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5800
  • Fax: 718-579-4700
Mailing address:
  • Phone: 631-643-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number173252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: