Healthcare Provider Details

I. General information

NPI: 1285022087
Provider Name (Legal Business Name): SRIDEVI LOKASUBRAMANIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178-10 WEXFORD TERRACE
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

178-10 WEXFORD TERRACE
JAMAICA ESTATES NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax: 718-658-7091
Mailing address:
  • Phone: 718-658-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number282002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: