Provider Demographics
NPI:1558658997
Name:VERNEKAR, SHILPA JEEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:JEEVAN
Last Name:VERNEKAR
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 1:182 PEBBLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3804
Mailing Address - Country:US
Mailing Address - Phone:410-948-3455
Mailing Address - Fax:
Practice Address - Street 1:1546 10TH AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3613
Practice Address - Country:US
Practice Address - Phone:706-322-5526
Practice Address - Fax:706-322-1237
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD31142208000000X
GA66662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty