Provider Demographics
NPI:1689003543
Name:SHANKARAIAH, PALLAVI (DO)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:
Last Name:SHANKARAIAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 S CONGRESS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2544
Mailing Address - Country:US
Mailing Address - Phone:561-964-0110
Mailing Address - Fax:
Practice Address - Street 1:3112 S CONGRESS AVE STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2544
Practice Address - Country:US
Practice Address - Phone:561-964-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14860208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty