Provider Demographics
NPI:1598708257
Name:KODALI, SASHIKANTH (MD)
Entity Type:Individual
Prefix:
First Name:SASHIKANTH
Middle Name:
Last Name:KODALI
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 1:515 W 59TH ST
Mailing Address - Street 2:APARTMENT #14 M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1047
Mailing Address - Country:US
Mailing Address - Phone:917-991-8667
Mailing Address - Fax:
Practice Address - Street 1:85 HERRICK STREET
Practice Address - Street 2:BEVERLY HOSPITAL
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-524-7937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine