Provider Demographics
NPI:1407218217
Name:SREEVALSAN, KAVYA
Entity Type:Individual
Prefix:
First Name:KAVYA
Middle Name:
Last Name:SREEVALSAN
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2130
Mailing Address - Fax:614-293-3087
Practice Address - Street 1:1800 ZOLLINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2849
Practice Address - Country:US
Practice Address - Phone:614-293-2130
Practice Address - Fax:614-293-3087
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35145724207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine