Provider Demographics
NPI:1790958114
Name:SHAIJU, ANEESHA (MD)
Entity Type:Individual
Prefix:
First Name:ANEESHA
Middle Name:
Last Name:SHAIJU
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 1:7276 SOUTHCREST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4228
Mailing Address - Country:US
Mailing Address - Phone:662-349-6577
Mailing Address - Fax:662-349-6562
Practice Address - Street 1:7276 SOUTHCREST PARKWAY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4228
Practice Address - Country:US
Practice Address - Phone:662-349-6577
Practice Address - Fax:662-349-6562
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics