Provider Demographics
NPI:1730301433
Name:VISWANATHA, SHANKAR NARAYAN
Entity Type:Individual
Prefix:MR
First Name:SHANKAR
Middle Name:NARAYAN
Last Name:VISWANATHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 42ND ST E
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1549
Mailing Address - Country:US
Mailing Address - Phone:229-392-3663
Mailing Address - Fax:229-387-0568
Practice Address - Street 1:607 42ND ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1549
Practice Address - Country:US
Practice Address - Phone:229-392-3663
Practice Address - Fax:229-387-0568
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist