Provider Demographics
NPI:1124021225
Name:PAI, SANGEETH SHANBHAG (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETH
Middle Name:SHANBHAG
Last Name:PAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANGEETH
Other - Middle Name:
Other - Last Name:SHANBHAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:179 HOWARD PL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8157
Mailing Address - Country:US
Mailing Address - Phone:575-521-8500
Mailing Address - Fax:575-521-8400
Practice Address - Street 1:179 HOWARD PL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8157
Practice Address - Country:US
Practice Address - Phone:575-521-8500
Practice Address - Fax:575-521-8400
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42504201Medicaid
NMNM400103Medicare PIN
NMH64134Medicare UPIN