Basic Information
Provider Information
NPI: 1003802554
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAVARATHINARAJAH
FirstName: SRIPRINTHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10051 5TH ST N STE 200
Address2:  
City: SAINT PETERSBURG
State: FL
PostalCode: 337022211
CountryCode: US
TelephoneNumber: 7278240780
FaxNumber: 8135148891
Practice Location
Address1: 10051 5TH ST N STE 200
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337022211
CountryCode: US
TelephoneNumber: 7278240780
FaxNumber: 8135148891
Other Information
ProviderEnumerationDate: 09/21/2005
LastUpdateDate: 03/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME106941FLY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X2005-00328NCN Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
00377320005FL MEDICAID


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