Healthcare Provider Details

I. General information

NPI: 1053553586
Provider Name (Legal Business Name): SHYAM S R ALLAMANENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 E GALBRAITH RD STE. 206
CINCINNATI OH
45236-6706
US

IV. Provider business mailing address

4750 E GALBRAITH RD STE. 206
CINCINNATI OH
45236-6706
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-1476
  • Fax: 513-686-5620
Mailing address:
  • Phone: 513-686-1476
  • Fax: 513-686-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.097908
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35.097908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: