Provider Demographics
NPI:1336273804
Name:KENI, SHREEDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHREEDEVI
Middle Name:
Last Name:KENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHREEDEVI
Other - Middle Name:HASSANKENI
Other - Last Name:ARUNKUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-5085
Mailing Address - Fax:661-836-3957
Practice Address - Street 1:5121 STOCKDALE HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2656
Practice Address - Country:US
Practice Address - Phone:661-868-5085
Practice Address - Fax:661-836-3957
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA375742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD34070Medicare UPIN
CAA375740Medicare ID - Type Unspecified