Healthcare Provider Details

I. General information

NPI: 1154016459
Provider Name (Legal Business Name): DR. SHILA POUDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 6TH ST STE 101
LAWRENCE KS
66044-2247
US

IV. Provider business mailing address

1112 W 6TH ST STE 101
LAWRENCE KS
66044-2247
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-5888
  • Fax: 785-505-5306
Mailing address:
  • Phone: 785-505-5888
  • Fax: 785-505-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-53289
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: