Provider Demographics
NPI:1831131622
Name:SHENDRIKAR, MANALI A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANALI
Middle Name:A
Last Name:SHENDRIKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANALI
Other - Middle Name:AVINASH
Other - Last Name:AYACHIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2021 SANTA MONICA BLVD STE 625E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2169
Mailing Address - Country:US
Mailing Address - Phone:310-829-8948
Mailing Address - Fax:424-212-5937
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 625E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-8948
Practice Address - Fax:424-212-5937
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine