Provider Demographics
NPI:1982636882
Name:SHESHADRI, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:SHESHADRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NEW WAVERLY PL
Mailing Address - Street 2:STE 310
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7404
Mailing Address - Country:US
Mailing Address - Phone:919-687-6900
Mailing Address - Fax:919-678-6901
Practice Address - Street 1:600 NEW WAVERLY PL
Practice Address - Street 2:STE 310
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7404
Practice Address - Country:US
Practice Address - Phone:919-687-6900
Practice Address - Fax:919-678-6901
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009900676174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG95741Medicare UPIN
NC7912038Medicaid