Provider Demographics
NPI:1548237399
Name:PRASAD, SHAKUNTALA (MD)
Entity Type:Individual
Prefix:
First Name:SHAKUNTALA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:MEMORIAL HOSPITAL OF RI / DEPT.OF PHYSICAL MED/REHAB
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-2326
Mailing Address - Fax:401-729-3886
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:MEMORIAL HOSPITAL OF RI / DEPT.OF PHYSICAL MED/REHAB
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2326
Practice Address - Fax:401-729-3886
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD06405208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087842AMedicaid
RI007057385OtherMEDICARE PTAN
RI7002088Medicaid
MA110087842AMedicaid