MEDICARE: DR. KAVITHA SHASHIKUMAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	100265	GA
2	207RI0200X	Infectious Disease Physician	L5558	TX
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	100265	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497858435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVITHA SHASHIKUMAR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 16387
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162-0387
Country	:	US
Telephone Number	:	817-294-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	6528 SAUCON VALLEY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5452
Country	:	US
Telephone Number	:	817-819-4919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	03/28/2025

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