1275949935 NPI number — DR. VARUN UMESH SHETTY M.D.

Table of content: SALLIE BUCHAN (NPI 1184143133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275949935 NPI number — DR. VARUN UMESH SHETTY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHETTY
Provider First Name:
VARUN
Provider Middle Name:
UMESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHETTY
Provider Other First Name:
VARUN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275949935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2886 W PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44120-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-894-5047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 TERRACE STREET, SCAIFE HALL, ROOM 651
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-818-1062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  MD467759 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 35.146997 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)