Provider Demographics
NPI:1952616724
Name:KADIYALA, SRILAKSHMI
Entity Type:Individual
Prefix:
First Name:SRILAKSHMI
Middle Name:
Last Name:KADIYALA
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 1:930 GRAND CONCOURSE
Mailing Address - Street 2:APT #10E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 GRAND CONCOURSE
Practice Address - Street 2:APT #10E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2705
Practice Address - Country:US
Practice Address - Phone:718-316-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205094455Medicare UPIN