Provider Demographics
NPI:1578810313
Name:SRIVASTAVA, SNIGDHA
Entity Type:Individual
Prefix:
First Name:SNIGDHA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 CLAYBOURNE ST APT 605
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1639
Mailing Address - Country:US
Mailing Address - Phone:954-682-2216
Mailing Address - Fax:
Practice Address - Street 1:4815 CENTRE AVE
Practice Address - Street 2:# 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1738
Practice Address - Country:US
Practice Address - Phone:412-578-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0392941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice