Provider Demographics
NPI:1861714867
Name:SWAMYSRIDHARA SIDDHARTHA, CHIKKANAYAKANAHALLI (CCC- SLP)
Entity type:Individual
Prefix:MR
First Name:CHIKKANAYAKANAHALLI
Middle Name:
Last Name:SWAMYSRIDHARA SIDDHARTHA
Suffix:
Gender:M
Credentials:CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 RURAL CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8382
Mailing Address - Country:US
Mailing Address - Phone:626-283-1490
Mailing Address - Fax:
Practice Address - Street 1:3330 RURAL CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8382
Practice Address - Country:US
Practice Address - Phone:626-283-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist