Provider Demographics
NPI:1548842156
Name:SRISKANDA, ANGELA ANUSHINI
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ANUSHINI
Last Name:SRISKANDA
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 1:371 MONTREAL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4411
Mailing Address - Country:US
Mailing Address - Phone:347-951-4666
Mailing Address - Fax:
Practice Address - Street 1:371 MONTREAL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4411
Practice Address - Country:US
Practice Address - Phone:347-951-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist