Basic Information
Provider Information
NPI: 1659733541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKELLA
FirstName: SRUTI
MiddleName: SARVARI
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 ACKERMAN RD STE 2120
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432021559
CountryCode: US
TelephoneNumber: 6142938116
FaxNumber: 6142935315
Practice Location
Address1: 915 OLENTANGY RIVER RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432123153
CountryCode: US
TelephoneNumber: 6142938116
FaxNumber: 6142935315
Other Information
ProviderEnumerationDate: 03/22/2016
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207WX0200X036151618ILN    
207W00000X35145280OHY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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