Provider Demographics
NPI:1225094378
Name:SRIVASTAVA, SUNIL K (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:K
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:MAIL CODE I32
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-636-2286
Mailing Address - Fax:216-445-4575
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAIL CODE I32
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-636-2286
Practice Address - Fax:216-445-4575
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3092451Medicaid
OH7418541Medicare PIN