Provider Demographics
NPI:1225545478
Name:SRIDHARAN, SOWMYA (ND,)
Entity Type:Individual
Prefix:
First Name:SOWMYA
Middle Name:
Last Name:SRIDHARAN
Suffix:
Gender:F
Credentials:ND,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900, S. STONEBRIDGE DR
Mailing Address - Street 2:# 1602
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:469-403-1999
Mailing Address - Fax:469-403-1999
Practice Address - Street 1:3900, S. STONEBRIDGE DR
Practice Address - Street 2:# 1602
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:469-403-1999
Practice Address - Fax:469-403-1999
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA0709175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath