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General NPI Number Information
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NPI Number | 1477695351
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Entity Type | Individual
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Provider Name | SRIVIDYA SRIDHARA M.D
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 623 W FM 544 STE 104
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City | MURPHY
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State | TX
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Zip | 75094-4577
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Country | US
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Telephone | 972-521-3366
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Fax | 972-422-5656
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Provider Business Mailing Address
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Address Line | 6210 GEORGIAN CT
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City | DALLAS
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State | TX
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Zip | 75254-8652
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Country | US
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Telephone | 408-431-0256
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Fax |
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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 | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | P4113
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A107039
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 53480
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License Number State | MN
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Taxonomy #4
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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 | 25109
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 104968
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License Number State | MN
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