Healthcare Provider Details

I. General information

NPI: 1902303522
Provider Name (Legal Business Name): SHILPA KALA SANNAPANENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHILPA KALA SANNAPANENI MD

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W COUGAR BLVD STE 602
PROVO UT
84604-3331
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-0570
  • Fax:
Mailing address:
  • Phone: 801-357-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301508115
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301508115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: