Healthcare Provider Details

I. General information

NPI: 1679215669
Provider Name (Legal Business Name): VIKASINI SHREYA MAHALINGAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE
AURORA CO
80045-2527
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1784
  • Fax:
Mailing address:
  • Phone: 617-726-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1027441
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: