Provider Demographics
NPI:1407891963
Name:SHENAVA, VINITHA R (MD)
Entity Type:Individual
Prefix:
First Name:VINITHA
Middle Name:R
Last Name:SHENAVA
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 1:2020 GRAVIER ST
Mailing Address - Street 2:CORRIDOR J, RM 330
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:504-568-4680
Mailing Address - Fax:504-568-4466
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9569
Practice Address - Fax:504-896-9849
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201545207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS254938OtherCOVENTRY
KS12393856OtherMULTIPLAN
KS105201OtherBCBS
KS14824OtherPHS
KS205235OtherHPK
KS200354150AMedicaid
KS14824OtherPHS
KS105021Medicare ID - Type Unspecified