Provider Demographics
NPI:1013197375
Name:SEETHARAM, SHABARI SANAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABARI
Middle Name:SANAT
Last Name:SEETHARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHABARI
Other - Middle Name:SANAT
Other - Last Name:BHATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3840 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5917
Mailing Address - Country:US
Mailing Address - Phone:602-232-6066
Mailing Address - Fax:
Practice Address - Street 1:3840 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5917
Practice Address - Country:US
Practice Address - Phone:602-232-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-013833207R00000X
WI52392207W00000X
IL036128066207W00000X
AZ46338207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist