Provider Demographics
NPI:1336415314
Name:SRINIVASAN, SHYLAJA (MD)
Entity Type:Individual
Prefix:
First Name:SHYLAJA
Middle Name:
Last Name:SRINIVASAN
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 1:355 ABBOTT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4483
Mailing Address - Country:US
Mailing Address - Phone:831-422-3636
Mailing Address - Fax:831-422-1255
Practice Address - Street 1:355 ABBOTT ST STE 200
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4483
Practice Address - Country:US
Practice Address - Phone:831-422-3636
Practice Address - Fax:831-422-1255
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1440252080P0205X
MA254937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics