Healthcare Provider Details

I. General information

NPI: 1750947347
Provider Name (Legal Business Name): SHRUTHI JANARDHANAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date: 01/13/2020
Reactivation Date: 01/28/2020

III. Provider practice location address

1712 E BROAD ST
RICHMOND VA
23223-6930
US

IV. Provider business mailing address

104 CRANBERRY RD
GALAX VA
24333-2682
US

V. Phone/Fax

Practice location:
  • Phone: 804-344-9848
  • Fax:
Mailing address:
  • Phone: 276-773-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101280430
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME157581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: