Provider Demographics
NPI:1396124608
Name:WANCHOO, SHESHALI JAIKRISHAN (DO)
Entity type:Individual
Prefix:
First Name:SHESHALI
Middle Name:JAIKRISHAN
Last Name:WANCHOO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST # 369
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-6366
Mailing Address - Fax:617-636-6361
Practice Address - Street 1:800 WASHINGTON ST # 369
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-6366
Practice Address - Fax:617-636-6361
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7155207R00000X, 2084A2900X
NY288699207R00000X
MA1015346207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care