Provider Demographics
NPI:1023037215
Name:GANTI, SHASHI D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:D
Last Name:GANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:557 W MORTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3383
Mailing Address - Country:US
Mailing Address - Phone:559-783-2700
Mailing Address - Fax:559-783-8020
Practice Address - Street 1:557 W MORTON AVE
Practice Address - Street 2:SUITE # 3
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3383
Practice Address - Country:US
Practice Address - Phone:559-783-2700
Practice Address - Fax:559-783-8020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38830207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388301Medicaid
CAA64424Medicare UPIN
CA00A388300Medicare ID - Type Unspecified
CA00A388301Medicare PIN