Healthcare Provider Details

I. General information

NPI: 1407891963
Provider Name (Legal Business Name): VINITHA R SHENAVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

2020 GRAVIER ST CORRIDOR J, RM 330
NEW ORLEANS LA
70112-2272
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9569
  • Fax: 504-896-9849
Mailing address:
  • Phone: 504-568-4680
  • Fax: 504-568-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD.201545
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: