Basic Information
| Provider Information | |||||||||
| NPI: | 1639326192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANNEGANTI | ||||||||
| FirstName: | SHALINI | ||||||||
| MiddleName: | RAO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3315 S 23RD ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535521200 | ||||||||
| FaxNumber: | 2535521239 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 S 23RD ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535521200 | ||||||||
| FaxNumber: | 2535521239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 70957 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD60297035 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | MD60297035 | WA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0299319 | 01 | WA | STATE L&I | OTHER | 0299812 | 01 | WA | STATE L&I | OTHER |