Provider Demographics
NPI:1821170093
Name:SKARIA, SHIBU DASAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIBU
Middle Name:DASAPPAN
Last Name:SKARIA
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 1:343 ELM ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4522
Mailing Address - Country:US
Mailing Address - Phone:775-770-7640
Mailing Address - Fax:775-770-7650
Practice Address - Street 1:343 ELM ST
Practice Address - Street 2:SUITE 402
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4522
Practice Address - Country:US
Practice Address - Phone:775-770-7640
Practice Address - Fax:775-770-7650
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-02521207RC0200X
NV13483207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1821170093Medicaid
NV1821170093Medicaid