Provider Demographics
NPI:1013309335
Name:ISHANI, SHELINA
Entity Type:Individual
Prefix:
First Name:SHELINA
Middle Name:
Last Name:ISHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELINA
Other - Middle Name:ZULFIKARALI
Other - Last Name:KHATAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6315 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1049
Mailing Address - Country:US
Mailing Address - Phone:952-426-1706
Mailing Address - Fax:
Practice Address - Street 1:6315 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1049
Practice Address - Country:US
Practice Address - Phone:952-426-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist