Healthcare Provider Details

I. General information

NPI: 1487159885
Provider Name (Legal Business Name): SRI LALITHA GARIMELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE
STATEN ISLAND NY
10314-3960
US

IV. Provider business mailing address

237 ELVIN ST
STATEN ISLAND NY
10314-5303
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-9001
  • Fax: 718-982-9008
Mailing address:
  • Phone: 408-930-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number311894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: