Provider Demographics
NPI:1023216827
Name:SHASTRI, PRIYA SUBRAMANYA (MD)
Entity Type:Individual
Prefix:MS
First Name:PRIYA
Middle Name:SUBRAMANYA
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2753
Mailing Address - Country:US
Mailing Address - Phone:978-922-2226
Mailing Address - Fax:781-744-5243
Practice Address - Street 1:83 HERRICK ST STE 1001
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2753
Practice Address - Country:US
Practice Address - Phone:978-922-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2480862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089736AMedicaid
MA110089736AMedicaid