Provider Demographics
NPI:1578582649
Name:MALHOTRA, SHISHUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHISHUKA
Middle Name:
Last Name:MALHOTRA
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 1:4825 HIGBEE AVE NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2567
Mailing Address - Country:US
Mailing Address - Phone:330-493-1118
Mailing Address - Fax:330-493-1154
Practice Address - Street 1:4825 HIGBEE AVE NW
Practice Address - Street 2:SUITE 120
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2567
Practice Address - Country:US
Practice Address - Phone:330-493-1247
Practice Address - Fax:330-493-1154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079074M2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335388Medicaid
OHH72618Medicare UPIN
OHMA4095053Medicare ID - Type Unspecified