Provider Demographics
NPI:1942316294
Name:KANCHERLA, SHAILAJA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:R
Last Name:KANCHERLA
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:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:
Practice Address - Street 1:6441 HIGH STAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5005
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233278208000000X
NC2006-00692208000000X
TXN8526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5570914OtherCIGNA
NY4C8266OtherHEALTH NET
NY7417726OtherAETNA - PPO
NYP3659664OtherOXFORD HEALTH PLAN
NY678X71OtherEMPIRE BC/BS
NY1078581OtherAETNA - HMO
NY685X71Medicare ID - Type Unspecified