Provider Demographics
NPI:1861626194
Name:ERANTI, SHANTI PRIYA
Entity Type:Individual
Prefix:DR
First Name:SHANTI
Middle Name:PRIYA
Last Name:ERANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHANTI
Other - Middle Name:PRIYA
Other - Last Name:KOILAKONDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:919-552-8914
Mailing Address - Fax:
Practice Address - Street 1:781 AVENT FERRY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-552-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194250207Q00000X
NC2012-01435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC7517BOtherMEDICARE PTAN