Provider Demographics
NPI:1396766168
Name:SHANARDI, GANESH (MD)
Entity type:Individual
Prefix:DR
First Name:GANESH
Middle Name:
Last Name:SHANARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 NW 56TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4316
Mailing Address - Country:US
Mailing Address - Phone:352-375-0287
Mailing Address - Fax:
Practice Address - Street 1:3925 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4565
Practice Address - Country:US
Practice Address - Phone:352-371-1777
Practice Address - Fax:352-371-0298
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH62946Medicare UPIN