Provider Demographics
NPI:1629741954
Name:ANANTHASIVAN, SNEHAJA (MD)
Entity Type:Individual
Prefix:
First Name:SNEHAJA
Middle Name:
Last Name:ANANTHASIVAN
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:TRINITY PEDIATRICS
Mailing Address - Street 2:5375 NORTH 9TH AVE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-941-7841
Mailing Address - Fax:850-332-0155
Practice Address - Street 1:TRINITY PEDIATRICS
Practice Address - Street 2:5375 NORTH 9TH AVE
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-941-7841
Practice Address - Fax:850-332-0155
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN34150390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program