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General NPI Number Information
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NPI Number | 1063975647
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Entity Type | Individual
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Provider Name | SHASHANK VODAPALLY DO
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Gender | Male
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 245 CHERRY ST SE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4607
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Country | US
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Telephone | 616-685-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SUMMER HILL CT
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City | CHESHIRE
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State | CT
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Zip | 06410-1361
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Country | US
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Telephone | 203-631-1104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101027901
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License Number State | MI
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