Shyam Prasad Shivareddy Peta, B.D.S., D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10690 Issued in CT

Practice address

85 Seymour St
Suite 1018
Hartford, CT 06106-5501

Phone

(860) 251-6999

Fax

(860) 251-6997

NPI assigned

Jul 15, 2010

Sex

Male

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 CT

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

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.

• Crest Family Dental, LLC

  • General Practice Dentistry
  • Hartford, CT
  • NPI 1699185264
  NPD (past)

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1720391071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 1018",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-251-6999",
            "fax_number": "860-251-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 1018",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-251-6999",
            "fax_number": "860-251-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVAREDDY PETA",
        "first_name": "SHYAM PRASAD",
        "name_prefix": "Dr.",
        "credential": "B.D.S., D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-15",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19179",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "10690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shiloh Counseling & Healing Services LLC
• Christopher Paul Shimwell, PA-C
• Peter Hun Shin, D.O.
• Dennis Earl Shipman, MSW, LCSW, LADC
• Laura Mae Shires I, LCSW
• Tannaz Shoja, MD
• Eric Shore, MD
• Kamal C Shoukri, MD
• Thanu Shree, M.D.
• Asmita Shrestha

• General Practice Dentistry in Hartford, CT
• Providers in Hartford, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.