Provider Demographics
NPI:1164950085
Name:KALYANASUNDARAM, SRIDEVI KARUMARI PRASATHAM (DNP)
Entity Type:Individual
Prefix:MRS
First Name:SRIDEVI
Middle Name:KARUMARI PRASATHAM
Last Name:KALYANASUNDARAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:323 OAK GLN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4705
Mailing Address - Country:US
Mailing Address - Phone:401-297-8181
Mailing Address - Fax:
Practice Address - Street 1:11180 WARNER AVE STE 165
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7515
Practice Address - Country:US
Practice Address - Phone:714-429-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily