Provider Demographics
NPI:1558303347
Name:KANAKIRIYA, SHARAN KUMAR
Entity Type:Individual
Prefix:
First Name:SHARAN
Middle Name:KUMAR
Last Name:KANAKIRIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2033 MEADOWVIEW LN STE 110
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-343-7801
Practice Address - Fax:423-343-7802
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58007207RN0300X
MN43405207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN732670000Medicaid
MN732670000Medicaid
H33182Medicare UPIN