Healthcare Provider Details

I. General information

NPI: 1720088768
Provider Name (Legal Business Name): SREE CHIRUMAMILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 1400
HAWTHORNE NY
10532-2144
US

IV. Provider business mailing address

22 SAW MILL RIVER RD 2ND FLOOR
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7513
  • Fax: 914-493-1281
Mailing address:
  • Phone: 914-593-7513
  • Fax: 914-493-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberR5100
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number256469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: