Provider Demographics
NPI:1467681759
Name:RAMINENI, SRIDIVYA I (MD)
Entity Type:Individual
Prefix:
First Name:SRIDIVYA
Middle Name:I
Last Name:RAMINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRIDIVYA
Other - Middle Name:I
Other - Last Name:VEERAVALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:866-837-6575
Practice Address - Street 1:1717 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-821-7565
Practice Address - Fax:480-821-4303
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine