Provider Demographics
NPI:1134186125
Name:SRINIVASA, SARALA HOSDURGA (MD)
Entity type:Individual
Prefix:DR
First Name:SARALA
Middle Name:HOSDURGA
Last Name:SRINIVASA
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 1:7752 SHELTER WOOD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2346
Mailing Address - Country:US
Mailing Address - Phone:904-472-1816
Mailing Address - Fax:
Practice Address - Street 1:7752 SHELTER WOOD CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2346
Practice Address - Country:US
Practice Address - Phone:904-472-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84718208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264159300Medicaid
FLP00457783OtherRR MEDICARE
FLP00457783OtherRR MEDICARE
FLG84552Medicare UPIN