Healthcare Provider Details

I. General information

NPI: 1568070993
Provider Name (Legal Business Name): SHANMUGAPRIYA DAKSHNAMOORTHY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74B CENTENNIAL LOOP
EUGENE OR
97401-7918
US

IV. Provider business mailing address

74B CENTENNIAL LOOP
EUGENE OR
97401-7918
US

V. Phone/Fax

Practice location:
  • Phone: 503-346-1640
  • Fax: 503-346-6918
Mailing address:
  • Phone: 503-346-1640
  • Fax: 503-346-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD227905
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: