Provider Demographics
NPI:1508159310
Name:SHASTRI, GHANSHYAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:GHANSHYAM
Middle Name:S
Last Name:SHASTRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1539
Mailing Address - Fax:270-752-2858
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 301E
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-762-1539
Practice Address - Fax:270-752-2858
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY46901207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100327800Medicaid
KY7100327800Medicaid