MEDICARE: NAGARAKERE SHANKARAIAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME57808	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588636450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAGARAKERE SHANKARAIAH MD

Provider Business Mailing Address
First Line	:	3112 S CONGRESS AVE
Second Line	:	STE A
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461
Country	:	US
Telephone Number	:	561-964-0110
Fax Number	:	561-964-0401

Provider Business Practice Location Address
First Line	:	3112 S CONGRESS AVE
Second Line	:	STE A
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461
Country	:	US
Telephone Number	:	561-964-0110
Fax Number	:	561-964-0401

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NAGARAKERE SHANKARAIAH
Credential	:	MD
Telephone Number	:	561-964-0110

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/22/2020

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