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General NPI Number Information
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NPI Number | 1487910295
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Entity Type | Individual
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Provider Name | SHANTI PRIYA SUBBARAO MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 301 E SOUTHLINE RD
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City | TUSCOLA
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State | IL
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Zip | 61953-2014
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Country | US
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Telephone | 217-253-5231
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Fax | 217-253-4082
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Provider Business Mailing Address
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Address Line | 611 W PARK ST FAPC
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.126085
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License Number State | OH
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Taxonomy #2
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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 #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036139178
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License Number State | IL
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