Provider Demographics
NPI:1902862832
Name:RAMAKRISHNA, SHILA (MD)
Entity Type:Individual
Prefix:
First Name:SHILA
Middle Name:
Last Name:RAMAKRISHNA
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 1:2013 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5426
Mailing Address - Country:US
Mailing Address - Phone:575-887-2455
Mailing Address - Fax:505-443-8320
Practice Address - Street 1:2013 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5426
Practice Address - Country:US
Practice Address - Phone:575-887-2455
Practice Address - Fax:505-443-8320
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93757069Medicaid
NM00NM00JD38OtherBCBS
NM00NM00JD38OtherBCBS
NMH96558Medicare UPIN