Provider Demographics
NPI:1316043136
Name:PRADHAN, SHILPA R (DO)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:R
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WALBERT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1700
Mailing Address - Country:US
Mailing Address - Phone:610-366-9160
Mailing Address - Fax:610-366-9164
Practice Address - Street 1:3420 WALBERT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1700
Practice Address - Country:US
Practice Address - Phone:610-366-9160
Practice Address - Fax:610-366-9164
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008095L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708128Medicaid
PA001708128Medicaid
PA276384Medicare ID - Type Unspecified