Provider Demographics
NPI:1508021841
Name:RAMANNA, SRIDHARA (MS, PHD, CCC)
Entity Type:Individual
Prefix:DR
First Name:SRIDHARA
Middle Name:
Last Name:RAMANNA
Suffix:
Gender:M
Credentials:MS, PHD, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 WOODMOSS LN APT 1A
Mailing Address - Street 2:AUTUMNWOODS APARTMENTS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1037
Mailing Address - Country:US
Mailing Address - Phone:317-842-1731
Mailing Address - Fax:
Practice Address - Street 1:5226 E 82ND ST
Practice Address - Street 2:REGENCY PLACE OF CASTLETON
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1628
Practice Address - Country:US
Practice Address - Phone:317-842-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004137A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist