Provider Demographics
NPI:1437824851
Name:VELUTHA MANNIL, SHIBINATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIBINATH
Middle Name:
Last Name:VELUTHA MANNIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-4383
Practice Address - Fax:718-653-2367
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2024-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-17561207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology