Provider Demographics
NPI:1700871589
Name:RAO, SHAKUNTALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKUNTALA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD RD
Mailing Address - Street 2:#236
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:216-449-9471
Mailing Address - Fax:216-449-7311
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:SUITE #236
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:216-449-9471
Practice Address - Fax:216-449-7311
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35049527R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0559711Medicaid
OH35049527ROtherSTATE LICENSE
OH35049527ROtherSTATE LICENSE