Provider Demographics
NPI:1215128020
Name:JANUMPALLY, SHIRISHA RANI (MD)
Entity type:Individual
Prefix:MS
First Name:SHIRISHA
Middle Name:RANI
Last Name:JANUMPALLY
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 1:3022 WILLIAMS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4600
Mailing Address - Country:US
Mailing Address - Phone:661-305-2853
Mailing Address - Fax:
Practice Address - Street 1:44902 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2314
Practice Address - Country:US
Practice Address - Phone:661-305-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012514312084N0400X
CAA874902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ448AMedicare PIN