Provider Demographics
NPI:1225183585
Name:SHASHIKALA AMENENI PLLC
Entity Type:Organization
Organization Name:SHASHIKALA AMENENI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHASHIKALA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMENENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-1093
Mailing Address - Street 1:4446 E DES MOINES ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6339
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:
Practice Address - Street 1:4446 E DES MOINES ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6339
Practice Address - Country:US
Practice Address - Phone:480-985-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty