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General NPI Number Information
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NPI Number | 1497858435
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Entity Type | Individual
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Provider Name | KAVITHA SHASHIKUMAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 6528 SAUCON VALLEY DR
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City | FORT WORTH
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State | TX
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Zip | 76132-5452
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Country | US
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Telephone | 817-819-4919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16387
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City | FORT WORTH
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State | TX
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Zip | 76162-0387
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Country | US
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Telephone | 817-294-1408
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 100265
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | L5558
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 100265
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License Number State | GA
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