Provider Demographics
NPI:1376074179
Name:GAVINI, SHASHITHA (DO)
Entity Type:Individual
Prefix:
First Name:SHASHITHA
Middle Name:
Last Name:GAVINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 PICARDY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3685
Mailing Address - Country:US
Mailing Address - Phone:225-308-0247
Mailing Address - Fax:225-308-0249
Practice Address - Street 1:8401 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3685
Practice Address - Country:US
Practice Address - Phone:225-308-0247
Practice Address - Fax:225-308-0249
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty