Basic Information
| Provider Information | |||||||||
| NPI: | 1124445002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARVEPALLI | ||||||||
| FirstName: | SHASHANK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 N OAK AVE STE D | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385012435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317835857 | ||||||||
| FaxNumber: | 9315266760 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 W GRAND AVE STE 2002 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454054722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374254144 | ||||||||
| FaxNumber: | 9374254146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD57335 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD57335 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | 35.131153 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.