Provider Demographics
NPI:1568462042
Name:NAIDU, SRILATA SRIRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SRILATA
Middle Name:SRIRAM
Last Name:NAIDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1055 STEWART AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3596
Practice Address - Country:US
Practice Address - Phone:516-938-0100
Practice Address - Fax:516-938-0120
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210490207W00000X
CT042801207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75653Medicare UPIN
180001021Medicare ID - Type Unspecified
6M9331Medicare PIN