Provider Demographics
NPI:1801311956
Name:GOWDA, SHASHIKALA BASAV (MD)
Entity type:Individual
Prefix:
First Name:SHASHIKALA
Middle Name:BASAV
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHASHIKALA
Other - Middle Name:BASAV
Other - Last Name:GOWDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-1171
Mailing Address - Fax:
Practice Address - Street 1:22201 MOROSS RD STE 252
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2175
Practice Address - Country:US
Practice Address - Phone:313-343-3809
Practice Address - Fax:313-417-0560
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57030228390200000X
OH390200000X
MI43015064942080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program