Provider Demographics
NPI:1497318042
Name:SRIVASTAV, AKANKSHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AKANKSHA
Middle Name:
Last Name:SRIVASTAV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4405
Mailing Address - Country:US
Mailing Address - Phone:740-707-0488
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE P297
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3904
Practice Address - Country:US
Practice Address - Phone:669-282-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist