Provider Demographics
NPI:1437593563
Name:TIRUNAGARI, SRESHTA SRI VAISHNAVI (MD)
Entity Type:Individual
Prefix:
First Name:SRESHTA
Middle Name:SRI VAISHNAVI
Last Name:TIRUNAGARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8259 166TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1820
Mailing Address - Country:US
Mailing Address - Phone:561-570-6029
Mailing Address - Fax:
Practice Address - Street 1:8259 166TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1820
Practice Address - Country:US
Practice Address - Phone:561-570-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155588207R00000X
FLME152398207R00000X
NY287068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine