Provider Demographics
NPI:1568797058
Name:SHASTRI, ADITI (MD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:SHASTRI
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 1:7675 PHOENIX DR
Mailing Address - Street 2:APT # 322
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4700
Mailing Address - Country:US
Mailing Address - Phone:713-798-0190
Mailing Address - Fax:
Practice Address - Street 1:ONE BAYLOR PLAZA
Practice Address - Street 2:BAYLOR COLLEGE OF MEDICINE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-7398
Practice Address - Country:US
Practice Address - Phone:713-798-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine