Individual
MALERY SHASHIDHARA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 2ND ST E, STE 3E, BRADENTON, FL 34208-1029
(941) 748-2417
(941) 748-3694
Mailing address
250 2ND ST E, STE 3E, BRADENTON, FL 34208-1029
(941) 748-2417
(941) 748-3694
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME0041924
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2905130
UNITED HEALTH CARE
—
01
—
4259049
AETNA PPO
—
01
—
656482
AETNA HMO
—
01
—
79772
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/23/2005
Last updated
07/08/2007
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