Provider Demographics
NPI:1982179644
Name:SRINIVASAN, ABHINAYA
Entity Type:Individual
Prefix:
First Name:ABHINAYA
Middle Name:
Last Name:SRINIVASAN
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 1:106 BANCROFT BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1812
Mailing Address - Country:US
Mailing Address - Phone:828-263-3429
Mailing Address - Fax:
Practice Address - Street 1:1750 NW MAYNARD RD STE 114
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3402
Practice Address - Country:US
Practice Address - Phone:984-302-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC15118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNONE