MEDICARE: PRIYANKA SRIVASTAV

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	207R00000X	Internal Medicine Physician	1202949	NC
2	207R00000X	Internal Medicine Physician	26045	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679956973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA SRIVASTAV

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 EASTCHESTER DR
Second Line	:	STE 200
City	:	HIGH POINT
State	:	NC
Zip	:	27265-3116
Country	:	US
Telephone Number	:	336-481-8610
Fax Number	:	336-481-8619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2015
Last Update Date	:	06/04/2026

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Directions to “ PRIYANKA SRIVASTAV ” Practice Location

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