MEDICARE: SHASHANK C. SRIVASTAVA, DPM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO1000041	DC

General Provider Information

NPI Number	:	1588979124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHASHANK C. SRIVASTAVA, DPM, LLC

Provider Business Mailing Address
First Line	:	2401 RESEARCH BLVD
Second Line	:	SUITE 350
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-3215
Country	:	US
Telephone Number	:	301-330-0468
Fax Number	:	301-330-3489

Provider Business Practice Location Address
First Line	:	1145 19TH STREET, NW
Second Line	:	SUITE 409
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3716
Country	:	US
Telephone Number	:	202-237-2106
Fax Number	:	301-330-3489

Authorized Official
Title or Position	:	OWNER
Name	:	SHASHANK CHANDRA SRIVASTAVA
Credential	:	DPM
Telephone Number	:	301-330-0468

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	01/03/2012

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