Provider Demographics
NPI:1396191987
Name:PASULA, SHIRISHA (MD)
Entity Type:Individual
Prefix:
First Name:SHIRISHA
Middle Name:
Last Name:PASULA
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:P.O. BOX 4012
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-0012
Mailing Address - Country:US
Mailing Address - Phone:330-270-2350
Mailing Address - Fax:330-270-2351
Practice Address - Street 1:540 PARMALEE AVE.
Practice Address - Street 2:SUITE 610
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1605
Practice Address - Country:US
Practice Address - Phone:330-744-4369
Practice Address - Fax:330-744-1728
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.141055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0467240Medicaid