Individual
SHYAM SUNDHAR ODETI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, FOURTH FLOOR, ABINGDON, VA 24211-7659
(276) 258-4050
(276) 258-4056
Mailing address
16000 JOHNSTON MEMORIAL DR, FOURTH FLOOR, ABINGDON, VA 24211-7659
(276) 258-4050
(276) 258-4056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101256639
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154614816
—
VA
01
—
P01493724
RAILROAD
VA
Enumeration date
05/27/2011
Last updated
09/18/2015
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