Provider Demographics
NPI:1598870735
Name:VASUDEVA, SHIKHA S (MD)
Entity Type:Individual
Prefix:
First Name:SHIKHA
Middle Name:S
Last Name:VASUDEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIKHA
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW STE 301
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-981-7715
Practice Address - Fax:540-981-7965
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010314925Medicaid
VA1598870735Medicaid
VA010314976Medicaid
VA010314950Medicaid
VA1598870735Medicaid
VA010314950Medicaid
VA010314976Medicaid
VAP00932736Medicare PIN
VAVV0508AMedicare PIN
011401C19Medicare PIN
VA011401C19Medicare PIN