Provider Demographics
NPI:1871955245
Name:SHASTRI, ADITI (MD)
Entity type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-8130
Mailing Address - Fax:510-506-7726
Practice Address - Street 1:500 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706-1103
Practice Address - Country:US
Practice Address - Phone:510-204-8130
Practice Address - Fax:510-506-7726
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA154052OtherSTATE MEDICAL LICENSE
CAFS8604616OtherFEDERAL DEA LICENSE