Provider Demographics
NPI:1023695806
Name:THAKER, SHIVANI K (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:K
Last Name:THAKER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST FL 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2506
Mailing Address - Country:US
Mailing Address - Phone:617-643-7568
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST FL 9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2506
Practice Address - Country:US
Practice Address - Phone:617-643-7568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program