Provider Demographics
NPI:1578791422
Name:SANGINENI, SHIREESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIREESHA
Middle Name:
Last Name:SANGINENI
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 1:405 OWEN DR STE 4000
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-3183
Mailing Address - Fax:910-745-8478
Practice Address - Street 1:405 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-3183
Practice Address - Fax:910-745-8478
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine