Provider Type Icon

DR. SASI KIRAN PENUKONDA MD NPI 1811220957


NPI Information

NPI: 1811220957
Provider Name: DR. SASI KIRAN PENUKONDA, MD
Classification: Pediatrics - 2080P0205X
Entity Type: Individual

Specialization: Pediatric Endocrinology

PECOS Registration: Yes

Address:
2032 ELIZABETH AVE
SHREVEPORT, LA
ZIP 71104
Phone: (318) 698-0035
Get Directions

DR. Sasi Kiran Penukonda, MD is a pediatric endocrinology pediatrics in Shreveport, LA. The provider is a pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. DR. Sasi Kiran Penukonda, MD NPI is 1811220957. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2032 ELIZABETH AVE
SHREVEPORT, LA
ZIP 71104-123
Phone: (318) 698-0035
Fax: (318) 698-0078

The NPI 1811220957 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/8/2009 and was last updated on 1/9/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics261269MASSACHUSETTSNo
22080P0205XPediatricsPediatric Endocrinology325077LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1110103822AMEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.