MEDICARE: SHASHIKALA AMENENI M.D.

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
1	207RI0200X	Infectious Disease Physician	30598	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1346229895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHASHIKALA AMENENI M.D.

Provider Business Mailing Address
First Line	:	LOCKBOX DEPT 880778
Second Line	:	PO BOX 29650
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:	480-648-7895
Fax Number	:	623-552-3320

Provider Business Practice Location Address
First Line	:	6040 E MAIN ST # 516
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-8928
Country	:	US
Telephone Number	:	480-648-7895
Fax Number	:	623-552-3320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/01/2025

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