Provider Demographics
NPI:1548303464
Name:SIRIVELLA, SRIKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:SRIKRISHNA
Middle Name:
Last Name:SIRIVELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIRIVELLA
Other - Middle Name:
Other - Last Name:SRIKRISHNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4000 SOUTH WEST, LOT M10
Mailing Address - Street 2:47TH STREET
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-336-3753
Mailing Address - Fax:
Practice Address - Street 1:ERIE AVE & FRONT STREET
Practice Address - Street 2:ST.CHRISTOPHER'S HOSPITAL FOR CHILDREN, CARDIOTHORACIC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1095
Practice Address - Country:US
Practice Address - Phone:215-427-5109
Practice Address - Fax:215-427-3860
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 03 1967 E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)