Provider Demographics
NPI:1962806851
Name:SANO, SHOTARO (DO)
Entity type:Individual
Prefix:DR
First Name:SHOTARO
Middle Name:
Last Name:SANO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 INTELLIPLEX DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8580
Mailing Address - Country:US
Mailing Address - Phone:317-392-0222
Mailing Address - Fax:
Practice Address - Street 1:2451 INTELLIPLEX DR STE 280
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-392-0222
Practice Address - Fax:317-392-0722
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005352A208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery