Provider Demographics
NPI:1245595719
Name:SRDANOVIC PARRIS, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SRDANOVIC PARRIS
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 1:1447 30TH DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3659
Mailing Address - Country:US
Mailing Address - Phone:917-402-6204
Mailing Address - Fax:
Practice Address - Street 1:1447 30TH DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3659
Practice Address - Country:US
Practice Address - Phone:917-402-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599419121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist