Provider Demographics
NPI:1952049090
Name:DR. SHALINI BOODRAM, MD, LLC
Entity Type:Organization
Organization Name:DR. SHALINI BOODRAM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOODRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-497-9456
Mailing Address - Street 1:1127 ROYAL PALM BEACH BLVD UNIT 312
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1641
Mailing Address - Country:US
Mailing Address - Phone:248-497-9456
Mailing Address - Fax:
Practice Address - Street 1:901 45 STREET
Practice Address - Street 2:RHAB ADMINISTRATION INTERFAITH-2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-884-6494
Practice Address - Fax:561-841-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty