Provider Demographics
NPI:1326302001
Name:SHRIVASTAVA, SHILPI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPI
Middle Name:
Last Name:SHRIVASTAVA
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7090
Mailing Address - Fax:515-643-7091
Practice Address - Street 1:350 E HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5005
Practice Address - Country:US
Practice Address - Phone:515-643-7090
Practice Address - Fax:515-643-7091
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA45296208000000X
IAMD-45296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics