Provider Demographics
NPI:1962661512
Name:PRABHU, SHREYA SUMAN (MD)
Entity type:Individual
Prefix:
First Name:SHREYA
Middle Name:SUMAN
Last Name:PRABHU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SHREYA
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 S 18TH ST STE 4C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2654
Mailing Address - Country:US
Mailing Address - Phone:614-224-6222
Mailing Address - Fax:
Practice Address - Street 1:555 S 18TH ST STE 4C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2654
Practice Address - Country:US
Practice Address - Phone:614-224-6222
Practice Address - Fax:614-241-5232
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35151074207WX0110X
OH35.151074207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392921Medicaid