Provider Demographics
NPI:1962174920
Name:SHASTRI, CHARMI HITESH (ATS)
Entity type:Individual
Prefix:MISS
First Name:CHARMI
Middle Name:HITESH
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BARTON ROAD
Mailing Address - Street 2:#212
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:657-505-6396
Mailing Address - Fax:
Practice Address - Street 1:901 SOUTH NATIONAL AVE
Practice Address - Street 2:PROFESSIONAL BUILDING 160
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-05-25
Deactivation Date:2023-04-19
Deactivation Code:
Reactivation Date:2023-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer