Provider Demographics
NPI:1720379506
Name:BOGGARAPU, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:BOGGARAPU
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 1:138 OLD SAN ANTONIO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3898
Mailing Address - Country:US
Mailing Address - Phone:303-552-3438
Mailing Address - Fax:830-268-8711
Practice Address - Street 1:138 OLD SAN ANTONIO RD STE 101
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3491
Practice Address - Country:US
Practice Address - Phone:830-355-2343
Practice Address - Fax:830-268-8711
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13435208000000X
TXR7177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN720478Medicare PIN