Provider Demographics
NPI:1700134095
Name:SRI RAYANI LLC
Entity Type:Organization
Organization Name:SRI RAYANI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-710-3100
Mailing Address - Street 1:462 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-9038
Mailing Address - Country:US
Mailing Address - Phone:740-710-3100
Mailing Address - Fax:
Practice Address - Street 1:462 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-9038
Practice Address - Country:US
Practice Address - Phone:740-710-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350938202084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4272032Medicare PIN