Provider Demographics
NPI:1992782726
Name:ARYA, SHASHANK (MD)
Entity type:Individual
Prefix:
First Name:SHASHANK
Middle Name:
Last Name:ARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WEXFORD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5655
Mailing Address - Country:US
Mailing Address - Phone:630-881-0924
Mailing Address - Fax:630-524-9018
Practice Address - Street 1:255 E BONITA AVENUE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-596-7845
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH76764Medicare UPIN
CAW13096Medicare ID - Type UnspecifiedGROUP