Provider Demographics
NPI:1568480341
Name:VATURI, SHANI (MD)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:VATURI
Suffix:
Gender:M
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:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0208
Mailing Address - Country:US
Mailing Address - Phone:330-448-3060
Mailing Address - Fax:330-448-2555
Practice Address - Street 1:7264 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9665
Practice Address - Country:US
Practice Address - Phone:330-448-3060
Practice Address - Fax:330-448-2555
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052456L207Q00000X
OH35062216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0930103Medicaid
PA0014975420002Medicaid
F03226Medicare UPIN
OH9334501Medicare PIN
PA070541Medicare PIN