Healthcare Provider Details

I. General information

NPI: 1467080051
Provider Name (Legal Business Name): SRUTHI SREEKUMAR PODUVAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD
FOREST HILLS NY
11375-7200
US

IV. Provider business mailing address

11835 QUEENS BLVD
FOREST HILLS NY
11375-7200
US

V. Phone/Fax

Practice location:
  • Phone: 929-809-0492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number336533
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: