Provider Demographics
NPI:1053553586
Name:ALLAMANENI, SHYAM S R (MD)
Entity type:Individual
Prefix:
First Name:SHYAM
Middle Name:S R
Last Name:ALLAMANENI
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 1:4750 E GALBRAITH RD
Mailing Address - Street 2:STE. 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6706
Mailing Address - Country:US
Mailing Address - Phone:513-686-1476
Mailing Address - Fax:513-686-5620
Practice Address - Street 1:4750 E GALBRAITH RD
Practice Address - Street 2:STE. 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6706
Practice Address - Country:US
Practice Address - Phone:513-686-1476
Practice Address - Fax:513-686-5620
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097908208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053308Medicaid
1715650OtherINDEPENDENT HEALTH
000531487001OtherBCBS OF WESTERN NY
NY03106214Medicaid
OHH024880Medicare PIN
OH0053308Medicaid