Healthcare Provider Details

I. General information

NPI: 1497638266
Provider Name (Legal Business Name): VSHIELD INFECTIOUS DISEASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 SANDERS RD
CUMMING GA
30041-5965
US

IV. Provider business mailing address

555 N POINT CTR E FL 4
ALPHARETTA GA
30022-8269
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-0001
  • Fax:
Mailing address:
  • Phone: 802-735-0001
  • Fax: 903-342-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KISHORE RASAMALLU
Title or Position: MD/OWNER
Credential:
Phone: 210-379-8553