Provider Demographics
NPI:1013730688
Name:SHANMUGAM, INDIRA
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:SHANMUGAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S MARKET ST APT 30
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1655
Mailing Address - Country:US
Mailing Address - Phone:614-359-4774
Mailing Address - Fax:
Practice Address - Street 1:617 S MARKET ST APT 30
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1655
Practice Address - Country:US
Practice Address - Phone:614-359-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker