Healthcare Provider Details

I. General information

NPI: 1336716240
Provider Name (Legal Business Name): SHIVANI KOTTUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax:
Mailing address:
  • Phone: 504-988-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: