Healthcare Provider Details

I. General information

NPI: 1902428907
Provider Name (Legal Business Name): SHREYAS ASHOK KALANTRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date: 01/11/2022
Reactivation Date: 03/01/2022

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6356
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8500
  • Fax: 513-584-4281
Mailing address:
  • Phone: 513-585-6200
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.155172
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: