Healthcare Provider Details

I. General information

NPI: 1659536696
Provider Name (Legal Business Name): ROOPA KANAKATTI SHANKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2121
  • Fax: 202-476-4095
Mailing address:
  • Phone: 202-476-2121
  • Fax: 202-476-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD046224
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: