Provider Demographics
NPI:1205219516
Name:SHANBHAG, ANUSHA GOPALKRISHNA
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:GOPALKRISHNA
Last Name:SHANBHAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1095
Mailing Address - Country:US
Mailing Address - Phone:812-532-2657
Mailing Address - Fax:812-532-2664
Practice Address - Street 1:606 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1095
Practice Address - Country:US
Practice Address - Phone:812-532-2657
Practice Address - Fax:812-532-2664
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56945207RC0000X
IN01087807A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease