Healthcare Provider Details

I. General information

NPI: 1871362517
Provider Name (Legal Business Name): RADHIKA SRIKHAKOLLU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3463 US-21 SUITE#101
FORT MILL SC
29715
US

IV. Provider business mailing address

1919 7TH AVE S
BIRMINGHAM AL
35233-2005
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-6065
  • Fax:
Mailing address:
  • Phone: 205-934-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11485
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: