Provider Demographics
NPI:1710081781
Name:SRIVASTAVA, SHAKTI DAYAL (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:SHAKTI
Middle Name:DAYAL
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1111 COLUMBUS ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-1939
Mailing Address - Country:US
Mailing Address - Phone:661-326-6546
Mailing Address - Fax:661-862-7604
Practice Address - Street 1:1111 COLUMBUS ST STE 3000
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305
Practice Address - Country:US
Practice Address - Phone:661-326-2800
Practice Address - Fax:661-862-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99233208M00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty