Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 248086 | MA |
NPI | 1023216827 |
---|---|
Provider Name | Ms. Priya Subramanya Shastri |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 24/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110089736A | (05) | MA |