Provider Demographics
NPI:1508931106
Name:SUNTHANKAR, SHIVALINI M (MD)
Entity Type:Individual
Prefix:
First Name:SHIVALINI
Middle Name:M
Last Name:SUNTHANKAR
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 1:1014 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1849
Mailing Address - Country:US
Mailing Address - Phone:970-482-8881
Mailing Address - Fax:970-482-3253
Practice Address - Street 1:1014 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1849
Practice Address - Country:US
Practice Address - Phone:970-482-8881
Practice Address - Fax:970-482-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01247881Medicaid
CO01247881Medicaid
COD24514Medicare UPIN