Provider Demographics
NPI:1568635548
Name:SHANKAR, NANDITA (MD)
Entity Type:Individual
Prefix:
First Name:NANDITA
Middle Name:
Last Name:SHANKAR
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 1:8200 W SUNRISE BLVD
Mailing Address - Street 2:#D-6
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:#D-6
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375985700Medicaid
FL375985700Medicaid
FL25745Medicare PIN