Provider Demographics
NPI:1578661468
Name:ADENI, SHUBHA (MD)
Entity Type:Individual
Prefix:
First Name:SHUBHA
Middle Name:
Last Name:ADENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHUBHA
Other - Middle Name:GRAMA
Other - Last Name:RANGANATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:3108 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5635
Practice Address - Country:US
Practice Address - Phone:512-654-4200
Practice Address - Fax:512-654-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3217208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160675802Medicaid
TX160675801Medicaid