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NPI Code Detail

MEDICARE: DR. SUBRAMANYA R SHASTRI MD

MEDICARE:  DR. SUBRAMANYA R SHASTRI  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist135351-1NY

General Provider Information

NPI Number : 1073527594
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUBRAMANYA R SHASTRI MD
Provider Business Mailing Address
First Line : 17 LIMESTONE DR STE 1
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8600
Country : US
Telephone Number : 716-565-3390
Fax Number : 716-565-3392
Provider Business Practice Location Address
First Line : 17 LIMESTONE DR STE 1
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8600
Country : US
Telephone Number : 716-565-3390
Fax Number : 716-565-3392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/08/2007

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Directions to “ DR. SUBRAMANYA R SHASTRI MD” Practice Location

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