Provider Demographics
NPI:1942464946
Name:LINGAMANENI, SHANMUKESH (MD)
Entity Type:Individual
Prefix:
First Name:SHANMUKESH
Middle Name:
Last Name:LINGAMANENI
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 1:481 HARBOUR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7449
Mailing Address - Country:US
Mailing Address - Phone:915-545-3029
Mailing Address - Fax:
Practice Address - Street 1:481 HARBOUR VIEW DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7449
Practice Address - Country:US
Practice Address - Phone:915-545-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38110207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine