Provider Demographics
NPI:1639380371
Name:MANE, SHIKHA (MD)
Entity Type:Individual
Prefix:
First Name:SHIKHA
Middle Name:
Last Name:MANE
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 1:2617 SCRIPTURE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2398
Mailing Address - Country:US
Mailing Address - Phone:940-382-4142
Mailing Address - Fax:940-382-7620
Practice Address - Street 1:2617 SCRIPTURE ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2398
Practice Address - Country:US
Practice Address - Phone:940-382-4142
Practice Address - Fax:940-382-7620
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4801207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-4361713OtherTAX ID
LA07920Medicaid