Provider Demographics
NPI:1255745188
Name:SHESHADRI, BHAIRAVI (MD)
Entity type:Individual
Prefix:DR
First Name:BHAIRAVI
Middle Name:
Last Name:SHESHADRI
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 1:2709 BLUE RIDGE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:919-876-7692
Mailing Address - Fax:919-954-3365
Practice Address - Street 1:2709 BLUE RIDGE RD STE 320
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-876-7692
Practice Address - Fax:919-954-3365
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2021-00280207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty