Provider Demographics
NPI:1518493469
Name:SRIVASTAVA, SRISHTI (MD)
Entity Type:Individual
Prefix:MISS
First Name:SRISHTI
Middle Name:
Last Name:SRIVASTAVA
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:PO BOX 2197
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2197
Mailing Address - Country:US
Mailing Address - Phone:870-262-1200
Mailing Address - Fax:
Practice Address - Street 1:1700 HARRISON ST STE T
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7315
Practice Address - Country:US
Practice Address - Phone:870-262-6155
Practice Address - Fax:870-262-6152
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-04-03
Deactivation Date:2017-12-14
Deactivation Code:
Reactivation Date:2018-10-17
Provider Licenses
StateLicense IDTaxonomies
ARE-15242207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine