Provider Demographics
NPI:1396470100
Name:RAJKUMAR, SHIVANI KAMALDEVI (DMD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:KAMALDEVI
Last Name:RAJKUMAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N ORLANDO AVE APT 345
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4493
Mailing Address - Country:US
Mailing Address - Phone:786-253-9883
Mailing Address - Fax:
Practice Address - Street 1:415 S ORLANDO AVE STE 212
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3683
Practice Address - Country:US
Practice Address - Phone:407-279-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN273671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice