Healthcare Provider Details

I. General information

NPI: 1144415167
Provider Name (Legal Business Name): MAYA DEVI SRIVASTAVA MD PH DPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 YOUNGS RD STE 208
WILLIAMSVILLE NY
14221-2644
US

IV. Provider business mailing address

1000 YOUNGS RD STE 208
WILLIAMSVILLE NY
14221-2644
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-0525
  • Fax: 716-688-0569
Mailing address:
  • Phone: 716-688-0525
  • Fax: 716-688-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number202393
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number202393
License Number StateNY

VIII. Authorized Official

Name: MARGARET LAW
Title or Position: BILLING MANAGER
Credential:
Phone: 716-656-0078