Provider Demographics
NPI:1316189673
Name:LAXMI, SHEETHAL MANIPADAGA (MD)
Entity Type:Individual
Prefix:
First Name:SHEETHAL
Middle Name:MANIPADAGA
Last Name:LAXMI
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:PO BOX 3003
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7003
Mailing Address - Country:US
Mailing Address - Phone:732-216-6273
Mailing Address - Fax:
Practice Address - Street 1:32 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1429
Practice Address - Country:US
Practice Address - Phone:732-462-4100
Practice Address - Fax:732-462-4549
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09435300207RI0200X
TXP7142207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
048996Medicare PIN