Provider Demographics
NPI:1700204070
Name:UPADHYAYA, SHASHI (DC)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:
Last Name:UPADHYAYA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 PLAZA VIA
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3224
Mailing Address - Country:US
Mailing Address - Phone:214-476-1665
Mailing Address - Fax:
Practice Address - Street 1:6735 PLAZA VIA
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3224
Practice Address - Country:US
Practice Address - Phone:214-476-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor