1558059311 NPI number — MS. SRUTHI SINDURA AVIRENI M.B.B.S.

Table of content: MS. SRUTHI SINDURA AVIRENI M.B.B.S. (NPI 1558059311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558059311 NPI number — MS. SRUTHI SINDURA AVIRENI M.B.B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVIRENI
Provider First Name:
SRUTHI
Provider Middle Name:
SINDURA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558059311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LINCOLN MEDICAL AND MENTAL HEALTH CENTER, DEPARTMENT OF
Provider Second Line Business Mailing Address:
PEDIATRICS, 324 EAST 149TH STREET ROOM 4-20
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-579-5030
Provider Business Mailing Address Fax Number:
718-579-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LINCOLN MEDICAL AND MENTAL HEALTH CENTER, DEPARTMENT OF
Provider Second Line Business Practice Location Address:
PEDIATRICS, 324 EAST 149TH STREET ROOM 4-20
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-5030
Provider Business Practice Location Address Fax Number:
718-579-4700
Provider Enumeration Date:
04/28/2023

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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