Provider Demographics
NPI:1659626554
Name:MAUZO, SHAKUNTALA HANUMANT (MBBS,MD)
Entity Type:Individual
Prefix:
First Name:SHAKUNTALA
Middle Name:HANUMANT
Last Name:MAUZO
Suffix:
Gender:F
Credentials:MBBS,MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5995
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5995
Mailing Address - Country:US
Mailing Address - Phone:713-500-5302
Mailing Address - Fax:713-500-0712
Practice Address - Street 1:701 N. FIRST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0002
Practice Address - Country:US
Practice Address - Phone:217-788-3000
Practice Address - Fax:217-788-5577
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.145741207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology