Provider Demographics
NPI:1417959198
Name:SUNDRANI, SHANKER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANKER
Middle Name:
Last Name:SUNDRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 TRAWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3885
Mailing Address - Country:US
Mailing Address - Phone:915-590-1890
Mailing Address - Fax:915-590-1952
Practice Address - Street 1:3028 TRAWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3885
Practice Address - Country:US
Practice Address - Phone:915-590-1890
Practice Address - Fax:915-590-1952
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2017-02-21
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXL2019207T00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200402600OtherUS DEPT OF LABOR PROVIDER
TX1062432-06Medicaid
NM34039376Medicaid
7450354OtherAETNA INSURANCE PROVIDER
TX1062432-06Medicaid
NM34039376Medicaid