1770638173 NPI number — DR. SHALINI BOYAPATI M.D.

Table of content: DR. SHALINI BOYAPATI M.D. (NPI 1770638173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770638173 NPI number — DR. SHALINI BOYAPATI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYAPATI
Provider First Name:
SHALINI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770638173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 W BELVEDERE AVE
Provider Second Line Business Mailing Address:
DEPT. OF CREDENTIALING
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-601-5524
Provider Business Mailing Address Fax Number:
410-601-8946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FORT WORTH VA CLINIC
Provider Second Line Business Practice Location Address:
2201 SOUTHEAST LOOP 820
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-730-0000
Provider Business Practice Location Address Fax Number:
817-730-0601
Provider Enumeration Date:
01/24/2007

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: 207R00000X , with the licence number:  T1021 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: P18627 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D65616 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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