Provider Demographics
NPI:1477220770
Name:KALYAN K. SHASTRI M.D. PLLC
Entity Type:Organization
Organization Name:KALYAN K. SHASTRI M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHASTRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-408-7326
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-0004
Mailing Address - Country:US
Mailing Address - Phone:716-462-4600
Mailing Address - Fax:716-462-4645
Practice Address - Street 1:3488 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1545
Practice Address - Country:US
Practice Address - Phone:716-462-4600
Practice Address - Fax:716-462-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty