Provider Demographics
NPI:1477174084
Name:NANDAKUMAR, SHANKAR MULLOTH
Entity type:Individual
Prefix:
First Name:SHANKAR
Middle Name:MULLOTH
Last Name:NANDAKUMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2537
Mailing Address - Country:US
Mailing Address - Phone:512-923-9668
Mailing Address - Fax:
Practice Address - Street 1:1890 N REVERE CT STE 4100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7464
Practice Address - Country:US
Practice Address - Phone:757-282-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00732882084P0800X
TXU51782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry