Provider Demographics
NPI:1326054396
Name:SRIVASTAVA, VINAY CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:CHANDRA
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 1:1621 WEST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-0848
Mailing Address - Country:US
Mailing Address - Phone:407-322-4431
Mailing Address - Fax:407-322-4448
Practice Address - Street 1:1621 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32772-0848
Practice Address - Country:US
Practice Address - Phone:407-322-4431
Practice Address - Fax:407-322-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG57586Medicare UPIN