Provider Demographics
NPI:1770722050
Name:SHANBHOGUE, KRISHNA PRASAD (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:PRASAD
Last Name:SHANBHOGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALAMPADY
Other - Middle Name:KRISHNA PRASAD
Other - Last Name:SHANBHOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:660 1ST AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3295
Mailing Address - Country:US
Mailing Address - Phone:212-263-0232
Mailing Address - Fax:
Practice Address - Street 1:281 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2925
Practice Address - Country:US
Practice Address - Phone:212-844-8880
Practice Address - Fax:212-844-8881
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX428852085R0202X
NY2706922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03633956Medicaid
TX200929201Medicaid
NYA400090519Medicare PIN
TX200929201Medicaid