Healthcare Provider Details

I. General information

NPI: 1124445002
Provider Name (Legal Business Name): SHASHANK SARVEPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE STE 2002
DAYTON OH
45405-4722
US

IV. Provider business mailing address

127 N OAK AVE STE D
COOKEVILLE TN
38501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 937-425-4144
  • Fax: 937-425-4146
Mailing address:
  • Phone: 931-783-5857
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD57335
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01091513A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.131153
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD57335
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: