Provider Demographics
NPI:1750947347
Name:JANARDHANAN, SHRUTHI (MD)
Entity type:Individual
Prefix:MISS
First Name:SHRUTHI
Middle Name:
Last Name:JANARDHANAN
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 1:104 CRANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2682
Mailing Address - Country:US
Mailing Address - Phone:276-773-2063
Mailing Address - Fax:
Practice Address - Street 1:104 CRANBERRY RD STE 200A
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-0009
Practice Address - Country:US
Practice Address - Phone:276-773-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-10-04
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-28
Provider Licenses
StateLicense IDTaxonomies
FLME157581207RH0002X
390200000X
VA0101280430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program