Individual
DR. SHYAM PRASAD SHIVAREDDY PETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.D.S., D.D.S
Contact information
Practice address
85 SEYMOUR ST, SUITE 1018, HARTFORD, CT 06106-5501
(860) 251-6999
(860) 251-6997
Mailing address
85 SEYMOUR ST, SUITE 1018, HARTFORD, CT 06106-5501
(860) 251-6999
(860) 251-6997
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10690
CT
1223G0001X
General Practice Dentistry
DN19179
FL
Other
Enumeration date
07/15/2010
Last updated
03/02/2015
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