MEDICARE: NEAL SHASTRI OD

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	152W00000X	Optometrist	TA2353	MD

General Provider Information

NPI Number	:	1497161749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL SHASTRI OD

Provider Business Mailing Address
First Line	:	6250 COLUMBIA CROSSING CIR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-8010
Country	:	US
Telephone Number	:	443-285-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 COLUMBIA CROSSING CIR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-8010
Country	:	US
Telephone Number	:	443-285-0100
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	11/06/2014

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