Healthcare Provider Details

I. General information

NPI: 1649024324
Provider Name (Legal Business Name): SHRUTHI SRIDHAR MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 01/16/2025
Certification Date:
Deactivation Date: 12/12/2024
Reactivation Date: 01/16/2025

III. Provider practice location address

2201 HEMPSTEAD TURNPIKE, EAST MEADOW
EAST MEADOW NY
11554
US

IV. Provider business mailing address

2201 HEMPSTEAD TURNPIKE, EAST MEADOW
EAST MEADOW NY
11554
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6501
  • Fax:
Mailing address:
  • Phone: 516-572-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: