Healthcare Provider Details

I. General information

NPI: 1225094378
Provider Name (Legal Business Name): SUNIL K SRIVASTAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE MAIL CODE I32
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE MAIL CODE I32
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-2286
  • Fax: 216-445-4575
Mailing address:
  • Phone: 216-636-2286
  • Fax: 216-445-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35096111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: