| Doctor Name: | SRIDEVI PRAVEEN |
| NPI Number: | 1023462702 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | R172477 |
| Business Practice Address: | 6439 Sedgwick St Elkridge, MD - 210756198 |
| Business Phone Number: | 3012751743 |
| Business Fax Number: | |
| Mailing Address: | 6439 Sedgwick St, ELKRIDGE |
| State: | MD |
| Postal Code: | 210756198 |
| Phone Number: | 3012751743 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2016 |
| NPI Last Update Date: | 04/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R172477 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |