MEDICARE: SHYAMALA GANTI 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
1	207R00000X	Internal Medicine Physician	35076166	OH

General Provider Information

NPI Number	:	1841211661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYAMALA GANTI MD

Provider Business Mailing Address
First Line	:	1756 W ANGELICA LOOP
Second Line	:	LECANTO
City	:	LECANTO
State	:	FL
Zip	:	34461-6400
Country	:	US
Telephone Number	:	937-271-1832
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 W MARC KNIGHTON CT
Second Line	:	LECANTO
City	:	LECANTO
State	:	FL
Zip	:	34461-6300
Country	:	US
Telephone Number	:	937-271-1832
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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