Provider Demographics
NPI:1457982571
Name:SURESHBABU, SHANKARI
Entity Type:Individual
Prefix:
First Name:SHANKARI
Middle Name:
Last Name:SURESHBABU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 32ND ST APT E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2403
Mailing Address - Country:US
Mailing Address - Phone:309-660-9270
Mailing Address - Fax:
Practice Address - Street 1:210 E 32ND ST APT E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2403
Practice Address - Country:US
Practice Address - Phone:309-660-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program