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NPI Code Detail

MEDICARE: DR. UDAYA KUMAR SHETTY M.D.

MEDICARE: DR. UDAYA KUMAR SHETTY 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
12084P0800XPsychiatry Physician0101047614VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1413533OTHERVAMAMSI
2244128OTHERVAANTHEM CLUE CROSS

General Provider Information

NPI Number : 1609838085
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. UDAYA KUMAR SHETTY M.D.
Provider Business Mailing Address
First Line : 3309 KLINE DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-6281
Country : US
Telephone Number : 757-431-1590
Fax Number : 757-481-6311
Provider Business Practice Location Address
First Line : 1745 CAMELOT DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-2435
Country : US
Telephone Number : 757-481-6000
Fax Number : 757-481-6311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 07/08/2007

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