Shakti K Matta, MBBS, DCH, MD, FAAP

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00035969 Issued in WA

Practice address

6802 W Rio Grande Ave Ste 1
Kennewick, WA 99336-7684

Phone

(509) 572-2201

Fax

(509) 783-8844

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

Yes

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)

Not 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.

• Pediatrics for You, PLLC

  • Pediatrics Physician
  • Kennewick, WA
  • NPI 1427240449
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1679652135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6802 W RIO GRANDE AVE STE 1",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367684",
            "telephone_number": "509-572-2201",
            "fax_number": "509-783-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6802 W RIO GRANDE AVE STE 1",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367684",
            "telephone_number": "509-572-2201",
            "fax_number": "509-783-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTA",
        "first_name": "SHAKTI",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MBBS, DCH, MD, FAAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00035969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE DL&I #",
            "identifier": "0124991",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8227530",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen R Matheson, DDS PS
• Mathews Chiropractic, PLLC
• Marshall S. Mathews, D.C.
• Sean L Mathews, D.M.D.
• Jamine M. Matkowski, RPH
• Maxcare LLC
• Clarence B May II, MD
• Mayra O Mayra Arzola
• Rebekah Mays, RN
• Henrietta Lorena Mayuga, MD

• Pediatrics Physician in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.