Provider Demographics
NPI:1497868806
Name:NANDITA SHANKAR MD PA
Entity Type:Organization
Organization Name:NANDITA SHANKAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-475-1735
Mailing Address - Street 1:8200 W SUNRISE BLVD
Mailing Address - Street 2:SUITE #D6
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5426
Mailing Address - Country:US
Mailing Address - Phone:954-475-1735
Mailing Address - Fax:954-475-1741
Practice Address - Street 1:8200 W SUNRISE BLVD
Practice Address - Street 2:SUITE #D6
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5426
Practice Address - Country:US
Practice Address - Phone:954-475-1735
Practice Address - Fax:954-475-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X
FLME64830305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375985700Medicaid
FL25745Medicare UPIN