Shanti Smitha Telikicherla Kandala

Primary specialty

DentistTaxonomy code 122300000X

License

DL13493 Issued in MA

Practice address

19 Tacoma St
Worcester, MA 01605-3516

Phone

(508) 854-2122

Fax

(508) 854-2122

NPI assigned

Jul 23, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1609842152
  Medicare reassignment NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1316324650
  NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Milford, MA
  • NPI 1992137426
  NPD (past)

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1659756252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052060",
            "telephone_number": "508-852-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 TACOMA ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053516",
            "telephone_number": "508-854-2122",
            "fax_number": "508-854-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 High St",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MA",
            "postal_code": "015102556",
            "country_code": "US",
            "telephone_number": "978-368-0340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "80 Redbud Way Apt 23",
            "address_purpose": "LOCATION",
            "city": "Marlborough",
            "state": "MA",
            "postal_code": "017525928",
            "country_code": "US",
            "telephone_number": "865-382-3915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "80 Redbud Way Apt 23",
            "address_purpose": "LOCATION",
            "city": "Marlborough",
            "state": "MA",
            "postal_code": "017525928",
            "country_code": "US",
            "telephone_number": "865-382-3915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "32 Concord St",
            "address_purpose": "LOCATION",
            "city": "Framingham",
            "state": "MA",
            "postal_code": "017028302",
            "country_code": "US",
            "telephone_number": "508-270-2635",
            "fax_number": "508-370-0113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TELIKICHERLA KANDALA",
        "first_name": "SHANTI SMITHA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DL12643",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DL13493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monyenou Tehoue
• Amaryllis P Teixeira, FNP
• Ashley Tejada
• Joseph Jack Bockarie Tejan, MD
• Tele-Physicians PC
• Joshua Tello, CRNA
• Emmanuella Tem
• Samantha Temple
• Wendy Jeanne Temple, RN
• Riley Templer

• Dentist in Worcester, MA
• Providers in Worcester, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.