Provider Demographics
NPI:1255645859
Name:SHASHANK C. SRIVASTAVA,DPM,LLC
Entity type:Organization
Organization Name:SHASHANK C. SRIVASTAVA,DPM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHASHANK
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-237-0038
Mailing Address - Street 1:2401 RESEARCH BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3215
Mailing Address - Country:US
Mailing Address - Phone:301-330-0468
Mailing Address - Fax:301-330-3489
Practice Address - Street 1:3301 NEW MEXICO AVENUE NW
Practice Address - Street 2:SUITE 221
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3610
Practice Address - Country:US
Practice Address - Phone:202-237-0038
Practice Address - Fax:202-237-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000041213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5329910002Medicare NSC
MDU97245Medicare UPIN