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General NPI Number Information
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NPI Number | 1114504057
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Entity Type | Individual
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Provider Name | GEETIKA SRIVASTAVA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2600 6TH ST SW STE A2-710
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City | CANTON
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State | OH
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Zip | 44710-1702
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Country | US
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Telephone | 330-454-8076
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Fax | 330-454-3927
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Provider Business Mailing Address
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Address Line | 2600 6TH ST SW STE A2-710
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City | CANTON
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State | OH
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Zip | 44710-1702
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Country | US
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Telephone | 330-454-8076
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Fax | 330-454-3927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 35.150489
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License Number State | OH
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