Vijaya Shastri, MD

Primary specialty

Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X

License

VS040679 Issued in MI

Practice address

3950 Hollywood Rd
Suite 270
Saint Joseph, MI 49085-9159

Phone

(269) 983-3386

Fax

(269) 983-7943

NPI assigned

Mar 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeside Healthcare Specialists PLLC

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1467527648

  Adolescent Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1245299502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 HOLLYWOOD RD",
            "address_2": "SUITE 270",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859159",
            "telephone_number": "269-983-3386",
            "fax_number": "269-983-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 HOLLYWOOD RD",
            "address_2": "SUITE 270",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859159",
            "telephone_number": "269-983-3386",
            "fax_number": "269-983-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHASTRI",
        "first_name": "VIJAYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "MI",
            "license": "VS040679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "370016279",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0A110280",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon L Groh, Ma, LPC Counseling, PLLC
• Sharkey Chiropractic P.C.
• Kushagra Sharma
• Tushar D Sharma
• Subramaniam R Shastri, MD
• Jane Shaw, CRNA
• Shepard House Counseling & Psychological Services, P.C.
• Birgit Sherwin
• Craig Francis Sherwood, DPM
• Prajna Shetty

• Adolescent Medicine (Internal Medicine) Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Adolescent Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.