Provider Demographics
NPI:1376948604
Name:LADAK, SHENIF (MD)
Entity Type:Individual
Prefix:DR
First Name:SHENIF
Middle Name:
Last Name:LADAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:
Other - Last Name:LADAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT STE 208
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:512-628-3314
Practice Address - Street 1:12380 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2511
Practice Address - Country:US
Practice Address - Phone:314-447-9700
Practice Address - Fax:314-447-9812
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0501208D00000X
SC83332208D00000X
MO2017002247208100000X
NC2014-01584208D00000X
IL036149937208D00000X
TN000000064215208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCL490AOtherMEDICARE PTAN