Individual provider Active NPI

Srilatha Eadara, DO

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1316529688
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
332679 Issued in NY
Practice address
374 Stockholm St
Brooklyn, NY 11237-4006
Phone
(718) 963-7272
NPI assigned
Apr 26, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 332679 NY Primary

Addresses

Primary practice location

374 Stockholm St
Brooklyn, NY 11237-4006

Mailing address

374 Stockholm St
Brooklyn, NY 11237-4006
Phone (718) 963-7272

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250113001812 NY Practitioner - Pediatric Medicine 9739617176 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
332679NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Wyckoff Professional Medical Services, PC Pediatrics CurrentSince Nov 1, 2024 Accepting new patients
Wyckoff Heights Medical Center Past Accepting new patients

Locations

1411 Myrtle Ave
Brooklyn, NY 11237
Phone (718) 907-4301

374 Stockholm St
Brooklyn, NY 11237
Phone (718) 963-6485

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1316529688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EADARA",
        "first_name": "SRILATHA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-26",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "332679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.