Healthcare Provider Details

I. General information

NPI: 1093626731
Provider Name (Legal Business Name): NEHA SRINIVAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1100
US

IV. Provider business mailing address

225 E 39TH ST APT 16I
NEW YORK NY
10016-2290
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8100
  • Fax:
Mailing address:
  • Phone: 732-258-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number028453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: