Provider Demographics
NPI:1164461562
Name:AYER, SHASHIDHARAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHIDHARAN
Middle Name:B
Last Name:AYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHASHI
Other - Middle Name:B
Other - Last Name:AYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0245
Mailing Address - Country:US
Mailing Address - Phone:434-392-7615
Mailing Address - Fax:434-392-7616
Practice Address - Street 1:1801 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2905
Practice Address - Country:US
Practice Address - Phone:434-392-7615
Practice Address - Fax:434-392-7616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047258207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA052419Medicaid
VA052419Medicaid