Provider Demographics
NPI:1922767078
Name:SHASHIDHAR, SANJANA (OD)
Entity type:Individual
Prefix:DR
First Name:SANJANA
Middle Name:
Last Name:SHASHIDHAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6026
Mailing Address - Fax:866-936-4559
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT OPHTHALMOLOGY, STE 3110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6026
Practice Address - Fax:866-936-4559
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021048811152WP0200X, 152WC0802X, 152WP0200X, 152WV0400X
IL046011695152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy