Provider Demographics
NPI:1366754509
Name:AKSHINTALA, SRIVANDANA (MB,BS)
Entity type:Individual
Prefix:
First Name:SRIVANDANA
Middle Name:
Last Name:AKSHINTALA
Suffix:
Gender:F
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:DEPT OF HEMATOLOGY/ONCOLOGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-2800
Mailing Address - Fax:202-476-5685
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:DEPT OF HEMATOLOGY/ONCOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-2800
Practice Address - Fax:202-476-5685
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics