Provider Demographics
NPI:1255425641
Name:SHALINI, KOTHANDAPANY S (MD)
Entity type:Individual
Prefix:
First Name:KOTHANDAPANY
Middle Name:S
Last Name:SHALINI
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 1:1435 S ALMA SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:480-668-1600
Mailing Address - Fax:480-668-1615
Practice Address - Street 1:1435 S ALMA SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-668-1600
Practice Address - Fax:480-668-1615
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20030596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28201841Medicaid
348404401Medicare PIN
NM28201841Medicaid