Healthcare Provider Details

I. General information

NPI: 1639761984
Provider Name (Legal Business Name): MAYA SRINATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAKEVILLE RD STE M41
NEW HYDE PARK NY
11042-1117
US

IV. Provider business mailing address

450 LAKEVILLE RD STE M41
NEW HYDE PARK NY
11042-1117
US

V. Phone/Fax

Practice location:
  • Phone: 516-734-8567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number345057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: