Provider Demographics
NPI:1588632335
Name:REDDY, SHASHI KANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:KANT
Last Name:REDDY
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 1:5446 AMBER CIR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3142
Mailing Address - Country:US
Mailing Address - Phone:818-340-7827
Mailing Address - Fax:
Practice Address - Street 1:2925 SYCAMORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1207
Practice Address - Country:US
Practice Address - Phone:805-583-0944
Practice Address - Fax:805-583-0155
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH68152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786630Medicaid
CA00A786630Medicaid
CAH68152Medicare UPIN