Provider Demographics
NPI:1083858476
Name:SIRAM, GAYATRI
Entity Type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:SIRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 DOUGLAS ROAD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-447-4150
Mailing Address - Fax:305-675-8068
Practice Address - Street 1:820 DOUGLAS ROAD
Practice Address - Street 2:SUITE 820
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-447-4150
Practice Address - Fax:305-675-8068
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3334618207L00000X
FLME113722207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118028500Medicaid