Provider Demographics
NPI:1720034978
Name:SIVASHANKER, SARAVANA E (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAVANA
Middle Name:E
Last Name:SIVASHANKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19139 NW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5336
Mailing Address - Country:US
Mailing Address - Phone:954-684-3098
Mailing Address - Fax:
Practice Address - Street 1:19139 NW 23RD CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5336
Practice Address - Country:US
Practice Address - Phone:954-684-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38975207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64093677Medicaid
KY64093677Medicaid
KY0955914Medicare ID - Type Unspecified