Individual
PRATIBHA SRINIVASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-A, CERT AVT
Contact information
Practice address
1495 CHAIN BRIDGE RD, MCLEAN, VA 22101-5727
(571) 633-0770
(571) 633-9666
Mailing address
4001 SPRINGFIELD RD, GLEN ALLEN, VA 23060-4181
(804) 290-0475
(804) 290-0476
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000379
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140801
PROVIDER ID - ANTHEM
VA
01
—
208069
PROVIDER ID - ANTHEM
VA
01
—
69161
PROVIDER ID/OPTIMA HEALTH
VA
Enumeration date
08/09/2006
Last updated
07/08/2007
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