Provider Demographics
NPI:1760549240
Name:SHREEVATSA, AJAI (MD)
Entity type:Individual
Prefix:DR
First Name:AJAI
Middle Name:
Last Name:SHREEVATSA
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 1:124 CHARLESTOWNE CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5716
Mailing Address - Country:US
Mailing Address - Phone:440-465-8290
Mailing Address - Fax:
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-2137
Practice Address - Fax:928-669-3131
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH89029207R00000X
NC2014-01417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000218191OtherUNISON
OH745494OtherBUCKEYE
MI1760549240Medicaid
OH000000506289OtherANTHEM
OH2720621Medicaid
OH415034OtherWELLCARE
OHP00385142OtherRAILROAD MEDICARE
7937887OtherAETNA
OHSH4203241Medicare PIN