Healthcare Provider Details

I. General information

NPI: 1336003375
Provider Name (Legal Business Name): DR. KEERTHI SHANKAR RAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 HALCYON RD
CLEVELAND OH
44122-1301
US

IV. Provider business mailing address

2141 HALCYON RD
CLEVELAND OH
44122-1301
US

V. Phone/Fax

Practice location:
  • Phone: 216-376-4875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberAPP-000949313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: