Provider Demographics
NPI:1124077540
Name:SUNDARESH, SHAILAJA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:
Last Name:SUNDARESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SPRINGSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26250 EUCLID AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3305
Practice Address - Country:US
Practice Address - Phone:216-261-2333
Practice Address - Fax:216-289-0748
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342598Medicaid
OHE35014Medicare UPIN
OH4063033Medicare PIN