Healthcare Provider Details

I. General information

NPI: 1083176234
Provider Name (Legal Business Name): SHASHANK REDDY MUSKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKS LN STE G20
JEFFERSON HILLS PA
15025-3752
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 412-267-5040
  • Fax: 412-384-3505
Mailing address:
  • Phone: 412-330-4461
  • Fax: 412-330-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD482342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: