Provider Demographics
NPI:1497976526
Name:CALLA, SHRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRISH
Middle Name:
Last Name:CALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHRISH
Other - Middle Name:K
Other - Last Name:KALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1565 SAXON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5876
Mailing Address - Country:US
Mailing Address - Phone:386-917-7395
Mailing Address - Fax:386-532-7152
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-917-7395
Practice Address - Fax:386-532-7152
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine