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1508021841 NPI number — SRIDHARA RAMANNA M.S., PH.D., CCC

NPI Number: 1508021841
Health Care Provider/Practitioner: SRIDHARA RAMANNA M.S., PH.D., CCC

Information about “1508021841” NPI (SRIDHARA RAMANNA M.S., PH.D., CCC) exists in 1508021841 in HTML format HTML  |  1508021841 in plain Text format TXT  |  1508021841 in PDF (Portable Document Format) PDF  |  1508021841 in an XML format XML  formats.

NPI Number : 1508021841 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508021841",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RAMANNA",
    "FirstName": "SRIDHARA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.S., PH.D., CCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9040 WOODMOSS LN APT 1A",
    "SecondLineMailingAddress": "AUTUMNWOODS APARTMENTS",
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46250-1037",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-842-1731",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5226 E 82ND ST",
    "SecondLinePracticeLocationAddress": "REGENCY PLACE OF CASTLETON",
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46250-1628",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-842-6668",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/25/2008",
    "LastUpdateDate": "07/25/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "22004137A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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