Healthcare Provider Details

I. General information

NPI: 1457399818
Provider Name (Legal Business Name): PRADHEEP J SHANKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD SUITE 5360
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

100 E CAMPUS VIEW BLVD SUITE 160
COLUMBUS OH
43235-4647
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-7747
  • Fax: 614-340-7742
Mailing address:
  • Phone: 614-396-4733
  • Fax: 614-396-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35.090077
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number235185-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: