Provider Demographics
NPI:1205904281
Name:UMASHANKAR, SHANTALA (MD)
Entity type:Individual
Prefix:
First Name:SHANTALA
Middle Name:
Last Name:UMASHANKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 JACKSON STREET
Mailing Address - Street 2:APARTMENT 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:203-927-9192
Mailing Address - Fax:860-282-5850
Practice Address - Street 1:939 JACKSON STREET
Practice Address - Street 2:APARTMENT 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:203-927-9192
Practice Address - Fax:860-282-5850
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0285392084P0800X
CAC1420132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56771Medicare UPIN