Provider Demographics
NPI:1831446855
Name:SHANKAR, ANITA PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:PRIYA
Last Name:SHANKAR
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 1:925 E SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1477
Mailing Address - Country:US
Mailing Address - Phone:817-912-8800
Mailing Address - Fax:
Practice Address - Street 1:925 E SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1477
Practice Address - Country:US
Practice Address - Phone:817-912-8800
Practice Address - Fax:817-912-8810
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0362208000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program