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NPI Code Detail

MEDICARE: DR. KALYAN K SHASTRI MD

MEDICARE: DR. KALYAN K 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
12084N0400XNeurology Physician60 267346NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275794554
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KALYAN K SHASTRI MD
Provider Business Mailing Address
First Line : PO BOX 4
Second Line :
City : GETZVILLE
State : NY
Zip : 14068-0004
Country : US
Telephone Number : 972-408-7326
Fax Number : 908-282-3152
Provider Business Practice Location Address
First Line : 2950 ELMWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14217-1304
Country : US
Telephone Number : 716-462-4600
Fax Number : 716-462-4645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2008
Last Update Date : 03/31/2025

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