Provider Demographics
NPI:1265839336
Name:KANDASAMY, SRITHARANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRITHARANI
Middle Name:
Last Name:KANDASAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRITHARANI
Other - Middle Name:
Other - Last Name:VIMALAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5420
Mailing Address - Country:US
Mailing Address - Phone:781-431-5429
Mailing Address - Fax:781-431-5548
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5429
Practice Address - Fax:781-431-5548
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ83150207V00000X
MA261690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology