Provider Demographics
NPI:1376107367
Name:SOUNDRANAYAGAM, SHEAHAHN VIKASH (MD)
Entity type:Individual
Prefix:
First Name:SHEAHAHN
Middle Name:VIKASH
Last Name:SOUNDRANAYAGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 PERKINS CREEK DR APT 527
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7520
Mailing Address - Country:US
Mailing Address - Phone:985-870-5071
Mailing Address - Fax:
Practice Address - Street 1:2501 KENTUCKY AVE BAPTIST HEALTH PADUCAH
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:985-873-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA438655207R00000X, 207RN0300X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology