Provider Demographics
NPI:1740202860
Name:SIRIPURAPU, SHANTIPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:SHANTIPRIYA
Middle Name:
Last Name:SIRIPURAPU
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 1:9515 W CAMELBACK RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1355
Mailing Address - Country:US
Mailing Address - Phone:623-777-1720
Mailing Address - Fax:623-777-1799
Practice Address - Street 1:9515 W CAMELBACK RD
Practice Address - Street 2:SUITE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1355
Practice Address - Country:US
Practice Address - Phone:623-777-1720
Practice Address - Fax:623-777-1799
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37026208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234183Medicaid