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General NPI Number Information
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NPI Number | 1578067476
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Entity Type | Individual
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Provider Name | SHANTI PITTAMPALLI MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 127 N OAK AVE STE B
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City | COOKEVILLE
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State | TN
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Zip | 38501-2435
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Country | US
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Telephone | 931-783-2648
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Fax | 931-783-2649
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Provider Business Mailing Address
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Address Line | 140 W 7TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1726
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Country | US
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Telephone | 931-783-5582
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 67984
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License Number State | TN
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