Provider Demographics
NPI:1073501441
Name:SATYANARAYANA, SHANTHI NMI (MD)
Entity Type:Individual
Prefix:
First Name:SHANTHI
Middle Name:NMI
Last Name:SATYANARAYANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2479
Mailing Address - Country:US
Mailing Address - Phone:419-586-1618
Mailing Address - Fax:419-586-9886
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2479
Practice Address - Country:US
Practice Address - Phone:419-586-1618
Practice Address - Fax:419-586-9886
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0610799Medicaid
A16303Medicare UPIN
OH0577192Medicare ID - Type Unspecified