Provider Demographics
NPI:1568435576
Name:SHRINATH, SHYLA (MD)
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:
Last Name:SHRINATH
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 1:165 DARTMOUTH ST
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5123
Mailing Address - Country:US
Mailing Address - Phone:617-859-5100
Mailing Address - Fax:617-859-5050
Practice Address - Street 1:165 DARTMOUTH ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5123
Practice Address - Country:US
Practice Address - Phone:617-859-5100
Practice Address - Fax:617-859-5050
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J30215OtherBLUE SHIELD HMO BLUE
MA3118801Medicaid
F71057Medicare UPIN
MA3118801Medicaid