Provider Demographics
NPI:1720498629
Name:BONGU, SHALINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:
Last Name:BONGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 COMMON WAY RD
Mailing Address - Street 2:APT 203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6445
Mailing Address - Country:US
Mailing Address - Phone:706-910-5009
Mailing Address - Fax:
Practice Address - Street 1:6420 CLAYTON ROAD
Practice Address - Street 2:ST MARY'S HEALTH CENTER
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:706-910-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program