Provider Demographics
NPI:1619575487
Name:SREEBHAVI PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SREEBHAVI PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEKANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-289-7621
Mailing Address - Street 1:340 HAWKINS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6638
Mailing Address - Country:US
Mailing Address - Phone:972-546-5660
Mailing Address - Fax:972-782-5232
Practice Address - Street 1:340 HAWKINS RUN RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6638
Practice Address - Country:US
Practice Address - Phone:972-546-5660
Practice Address - Fax:972-782-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty