Individual
DR. SHANTHALA J SHIVANANJAPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 STANIFORD STREET, C/O MA ANESTHESIA CORP, BOSTON, MA 02114
(617) 665-1630
Mailing address
P.O. BOX 372, C/O MA ANESTHESIA CORP., STOUGHTON, MA 02072-0372
(781) 341-3966
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
217119
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2030331
—
MA
01
—
467250
TUFTS HEALTH PLAN
MA
01
—
J26878
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
12/13/2011
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