Provider Demographics
NPI:1821144502
Name:RAJ, SHAILAJA KS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:KS
Last Name:RAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KANAMANGALATH
Other - Middle Name:S
Other - Last Name:SHAILAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1871 MCCAULEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1512
Mailing Address - Country:US
Mailing Address - Phone:813-992-3519
Mailing Address - Fax:727-953-7668
Practice Address - Street 1:1871 MCCAULEY RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1512
Practice Address - Country:US
Practice Address - Phone:813-992-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99436207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280629100Medicaid
FLP00663692OtherRR MEDICARE
FLP00663692OtherRR MEDICARE