Provider Demographics
NPI:1083895262
Name:SHANKAR, MYTHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:MYTHRI
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43847 HEATON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4936
Mailing Address - Country:US
Mailing Address - Phone:661-414-5156
Mailing Address - Fax:408-351-4369
Practice Address - Street 1:43847 HEATON AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4936
Practice Address - Country:US
Practice Address - Phone:661-414-5156
Practice Address - Fax:408-351-4369
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69603207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine