Provider Demographics
NPI:1891796025
Name:VUPPALANCHI, SHIREESHA R (MD)
Entity Type:Individual
Prefix:
First Name:SHIREESHA
Middle Name:R
Last Name:VUPPALANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIREESHA
Other - Middle Name:R
Other - Last Name:NALAMASU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1621
Practice Address - Country:US
Practice Address - Phone:317-621-5676
Practice Address - Fax:317-621-5678
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056071A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200503410Medicaid
INP01209640OtherRR MEDICARE PTAN
IN251320PPPMedicare PIN
INP01209640OtherRR MEDICARE PTAN
INH72506Medicare UPIN