Provider Demographics
NPI:1568042943
Name:SRIVASTAVA, PRONOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRONOMA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GRADUATE MEDICAL EDUCATION OFFICE STONY BROOK MEDICINE
Mailing Address - Street 2:HSC LEVEL 4, ROOM 176
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-1739
Mailing Address - Country:US
Mailing Address - Phone:631-444-2955
Mailing Address - Fax:631-638-0069
Practice Address - Street 1:GRADUATE MEDICAL EDUCATION OFFICE STONY BROOK MEDICINE
Practice Address - Street 2:HSC LEVEL 4, ROOM 176
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-1739
Practice Address - Country:US
Practice Address - Phone:631-444-2955
Practice Address - Fax:631-638-0069
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program