1255396735 NPI number — DR. SHANTHI PRAKASH M.D.

Table of content: DR. SHANTHI PRAKASH M.D. (NPI 1255396735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255396735 NPI number — DR. SHANTHI PRAKASH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRAKASH
Provider First Name:
SHANTHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255396735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5937 BENEVA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34238-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-918-2011
Provider Business Mailing Address Fax Number:
941-918-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5937 BENEVA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34238-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-918-2011
Provider Business Practice Location Address Fax Number:
941-918-2046
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME84535 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00013893 . This is a "RR MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212789 . This is a "WELLCARE MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 945747001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 266979000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29059 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9119242 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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