Provider Demographics
NPI:1013205616
Name:MANAKTALA, SHOBHA (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHOBHA
Middle Name:
Last Name:MANAKTALA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 238TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1819
Mailing Address - Country:US
Mailing Address - Phone:347-731-9013
Mailing Address - Fax:
Practice Address - Street 1:525 W 238TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1819
Practice Address - Country:US
Practice Address - Phone:347-731-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist