Provider Demographics
NPI:1457047292
Name:GANESHAN, SHIVANGI (MBBS)
Entity Type:Individual
Prefix:
First Name:SHIVANGI
Middle Name:
Last Name:GANESHAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOID RD NW
Mailing Address - Street 2:GROUND FLOOR, ROOM GG011C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:202-444-1359
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program