Individual ProviderShashank VodapallyPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address245 Cherry St SE Ste 300, Grand Rapids, MI 49503-4607(616) 685-5050(203) 631-1104PECOS EnrollmentBased on the most recent information from CMS, provider Shashank Vodapally is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1063975647Provider TypeIndividualFull NameVodapally, ShashankTitleMr.CredentialDOGenderMaleSole ProprietorNoEnumeration Date4/10/2019Last Updated8/20/2024Contact InformationPractice LocationPractice Address245 Cherry St SE Ste 300, Grand Rapids, MI 49503-4607Phone(616) 685-5050FaxUnlisted FaxMailing LocationMailing Address35 Summer Hill Ct, Cheshire, CT 06410-1361Phone(203) 631-1104FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense5101027901MichiganCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer