Healthcare Provider Details

I. General information

NPI: 1588808075
Provider Name (Legal Business Name): SHASHANK SHEKHAR SINHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR SPC 5853 SUITE 2381
ANN ARBOR MI
48109-5853
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax: 703-776-7113
Mailing address:
  • Phone: 734-936-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301102349
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301102349
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101265038
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: