Provider Demographics
NPI:1326221649
Name:KATIKANENI, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:KATIKANENI
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 1:12200 PARK CENTRAL DR STE 189
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2116
Mailing Address - Country:US
Mailing Address - Phone:972-239-5445
Mailing Address - Fax:469-729-6691
Practice Address - Street 1:12200 PARK CENTRAL DR STE 189
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2116
Practice Address - Country:US
Practice Address - Phone:972-239-5445
Practice Address - Fax:469-729-6691
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10022509207R00000X
TXN0878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197841303Medicaid
TX197841304Medicaid
TX197841302Medicaid
TX8L10933Medicare PIN
TX8L10924Medicare PIN
TX197841303Medicaid
TX197841302Medicaid