Provider Demographics
NPI:1184039422
Name:SHIVASHANKAR, SANDYA (MD)
Entity Type:Individual
Prefix:
First Name:SANDYA
Middle Name:
Last Name:SHIVASHANKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:645 E STATE HIGHWAY 121 STE 600
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7942
Mailing Address - Country:US
Mailing Address - Phone:972-906-8107
Mailing Address - Fax:972-956-8887
Practice Address - Street 1:12801 MIDWAY RD STE 503
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6303
Practice Address - Country:US
Practice Address - Phone:972-243-3304
Practice Address - Fax:972-243-3717
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR3959207Q00000X
IL125.064639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine