Healthcare Provider Details

I. General information

NPI: 1073501441
Provider Name (Legal Business Name): SHANTHI NMI SATYANARAYANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S MAIN ST STE 2
CELINA OH
45822-2479
US

IV. Provider business mailing address

950 S MAIN ST STE 2
CELINA OH
45822-2479
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-1618
  • Fax: 419-586-9886
Mailing address:
  • Phone: 419-586-1618
  • Fax: 419-586-9886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-05-231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: