Healthcare Provider Details

I. General information

NPI: 1952373805
Provider Name (Legal Business Name): SHIVA S KRISHNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 8TH ST SE
DECATUR AL
35601-3356
US

IV. Provider business mailing address

101 WESTOVER CIR STE C
MADISON AL
35758-4910
US

V. Phone/Fax

Practice location:
  • Phone: 256-560-0646
  • Fax: 256-560-0649
Mailing address:
  • Phone: 256-890-0331
  • Fax: 256-325-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25205
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00025205
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: