Individual
VIJAYA SHASTRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 983-3386
(269) 983-7943
Mailing address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 983-3386
(269) 983-7943
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
VS040679
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A110280
BCBS
MI
01
—
370016279
RAIL ROAD MEDICARE
MI
Enumeration date
03/23/2006
Last updated
02/24/2016
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