Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301089092 | MI |
N | 2080P0210X | Pediatric Nephrologist | 4301089092 | MI |
NPI | 1588876445 |
---|---|
Provider Name | Sweety Ajay Srivastava |
First Address | Burton, MI 48519-1420 |
Second Address | Burton, MI 48519-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0-609-209-2 | ECFMG (01) | |
382406558 | HAMILTON TAX ID (01) | MI |
5175322 | (05) | MI |