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General NPI Number Information
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NPI Number | 1619396793
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Entity Type | Individual
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Provider Name | SRIDHAR B KADIYALA MBBS., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 79 MIDDLEVILLE RD
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City | NORTHPORT
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State | NY
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Zip | 11768
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Country | US
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Telephone | 631-261-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 662 VETERANS HWY APT 2F
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City | HAUPPAUGE
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State | NY
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Zip | 11788-1224
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Country | US
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Telephone | 518-763-7843
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 292923
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License Number State | NY
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