Provider Demographics
NPI:1982823290
Name:SIVA, DEVAKI (MD)
Entity Type:Individual
Prefix:
First Name:DEVAKI
Middle Name:
Last Name:SIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEVAKI
Other - Middle Name:
Other - Last Name:SIVASUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 204
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-9041
Practice Address - Country:US
Practice Address - Phone:941-923-1872
Practice Address - Fax:941-923-3947
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091718207RH0003X
WV23141207RH0003X
FLME163239207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000696928OtherANTHEM
OH2837167Medicaid
OH000000570137OtherANTHEM
WV3810012110Medicaid
OH000000570137OtherANTHEM
OH4238271OtherMEDICARE OH
OH7418661Medicare PIN
OHP00703831OtherRRMCR