Provider Demographics
NPI:1639326192
Name:KANNEGANTI, SHALINI RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:RAO
Last Name:KANNEGANTI
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 1:3315 S 23RD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1605
Mailing Address - Country:US
Mailing Address - Phone:253-552-1200
Mailing Address - Fax:253-552-1239
Practice Address - Street 1:3315 S 23RD ST
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1605
Practice Address - Country:US
Practice Address - Phone:253-552-1200
Practice Address - Fax:253-552-1239
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70957208600000X
WAMD60297035208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0299319OtherSTATE L&I
WA0299812OtherSTATE L&I
WAG8911546Medicare PIN