1093036733 NPI number — DR. ROSHNI SREEDHARAN M.D

Table of content: DR. ROSHNI SREEDHARAN M.D (NPI 1093036733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093036733 NPI number — DR. ROSHNI SREEDHARAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SREEDHARAN
Provider First Name:
ROSHNI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
S
Provider Other First Name:
ROSHNI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1093036733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19683 CHAGRIN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-551-7613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 EUCLID AVE
Provider Second Line Business Practice Location Address:
CLEVELAND CLINIC FOUNDATION
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-551-7613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 35.123055 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LC0200X , with the licence number: 35.123055 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)