Provider Demographics
NPI:1619382959
Name:BANKER, SHOBHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHANA
Middle Name:
Last Name:BANKER
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 1:8108 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7293
Mailing Address - Country:US
Mailing Address - Phone:973-216-1282
Mailing Address - Fax:
Practice Address - Street 1:2300 MARIE CURIE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5706
Practice Address - Country:US
Practice Address - Phone:214-857-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10142000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine