Healthcare Provider Details

I. General information

NPI: 1073423380
Provider Name (Legal Business Name): SHWETA SRIDHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N WATER ST
KENT OH
44240-2418
US

IV. Provider business mailing address

1450 E SUMMIT ST
KENT OH
44240-4034
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-3006
  • Fax:
Mailing address:
  • Phone: 330-554-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: