Healthcare Provider Details

I. General information

NPI: 1497868806
Provider Name (Legal Business Name): NANDITA SHANKAR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W SUNRISE BLVD SUITE #D6
PLANTATION FL
33322-5426
US

IV. Provider business mailing address

8200 W SUNRISE BLVD SUITE #D6
PLANTATION FL
33322-5426
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-1735
  • Fax: 954-475-1741
Mailing address:
  • Phone: 954-475-1735
  • Fax: 954-475-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberME64830
License Number StateFL

VIII. Authorized Official

Name: DR. NANDITA SHANKAR
Title or Position: NEUROLOGIST
Credential: MD
Phone: 954-475-1735