Individual
DR. VISALAKSHI SRINIVASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3661 S BABCOCK ST, 2ND FLOOR, MELBOURNE, FL 32901-8903
(321) 434-7611
(321) 727-3738
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-7611
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
35084470
OH
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME94188
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273765500
—
FL
01
—
U6270Y
FL MEDICARE
FL
Enumeration date
09/26/2005
Last updated
03/19/2020
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