Provider Demographics
NPI:1396817318
Name:BADLANI, SHYAM L (D AC, AP)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:L
Last Name:BADLANI
Suffix:
Gender:M
Credentials:D AC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12622 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1867
Mailing Address - Country:US
Mailing Address - Phone:305-596-1596
Mailing Address - Fax:
Practice Address - Street 1:12622 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1867
Practice Address - Country:US
Practice Address - Phone:305-596-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist