Provider Demographics
NPI:1861628364
Name:SHANKARAN, SHIVANJALI (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANJALI
Middle Name:
Last Name:SHANKARAN
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 1:600 S PAULINA ST STE 140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-5865
Mailing Address - Fax:
Practice Address - Street 1:600 S PAULINA ST STE 140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249722207RI0200X
IL036-143813207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-032OtherTRICARE/CHAMPUS
VA1861628364OtherUNITED HEALTHCARE
VAPAROtherMULTIPLAN
VA456782OtherANTHEM BC/BS
NC5920094Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL
VA10091628OtherOPTIMA HEALTH
VA1861628364OtherVIRGINIA PREMIER HEALTH PLAN
VA1861628364Medicaid
VAPAROtherCIGNA
VA1861628364OtherFIRST HEALTH COMMERICAL/COVENTRY HEALTH
VAPAROtherAETNA
VAPAROtherAETNA
VAVV5874AMedicare PIN