Healthcare Provider Details

I. General information

NPI: 1508144593
Provider Name (Legal Business Name): SHOBHANA TALUKDAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N WILMOT RD STE 151
TUCSON AZ
85711-2701
US

IV. Provider business mailing address

PO BOX 910221
DALLAS TX
75391-0221
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-0206
  • Fax: 520-886-0829
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301098295
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number64211
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: