Sriram V Myneni, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010590 Issued in CT

Practice address

935 Main St
Suite # B2
Manchester, CT 06040-6059

Phone

(860) 643-0011

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 2, 2024.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1144320367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 MAIN ST STE B2",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060406050",
            "telephone_number": "860-643-0011",
            "fax_number": "860-646-8548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 MAIN ST",
            "address_2": "SUITE # B2",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060406059",
            "telephone_number": "860-643-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYNENI",
        "first_name": "SRIRAM",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Hogan Musco, PA
• Evelyn Musserenden
• Edith Mwenelupembe
• Jonathan Myette
• Myeyedr Optometry of Connecticut, LLC
• Kristen L Myshrall, MFT
• Jennifer Marie Wilson Nadeau, LCSW
• Natalie Nicole Nadeau, MS, LMFT
• Madhura Naik
• Pearl L Napoleon

• All providers in Manchester, CT
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.