Healthcare Provider Details

I. General information

NPI: 1396971925
Provider Name (Legal Business Name): ROSITA SADHANA SHIVDAT-NANHOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSITA SADHANA NANHOE MD

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116A HOSPITAL DR
WARNER ROBINS GA
31088-4204
US

IV. Provider business mailing address

116 HOSPITAL DR STE A
WARNER ROBINS GA
31088-4204
US

V. Phone/Fax

Practice location:
  • Phone: 478-225-2297
  • Fax:
Mailing address:
  • Phone: 478-733-6803
  • Fax: 478-225-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number62081
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number62081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: