Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 104968 | MN |
Y | 207K00000X | Allergist & Immunologist | 53480 | MN |
N | 207K00000X | Allergist & Immunologist | A107039 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | P4113 | TX |
NPI | 1477695351 |
---|---|
Provider Name | Dr. Srividya Sridhara |
First Address | Plano, TX 75025-6915 |
Second Address | Murphy, TX 75094-4577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |