Healthcare Provider Details

I. General information

NPI: 1942362520
Provider Name (Legal Business Name): SHANTANU SHREEPAD NAIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY STE 412
CEDAR PARK TX
78613-5015
US

IV. Provider business mailing address

6300 LA CALMA DR. STE. 200
AUSTIN TX
78752-3825
US

V. Phone/Fax

Practice location:
  • Phone: 512-379-3636
  • Fax: 512-379-3641
Mailing address:
  • Phone: 888-800-8237
  • Fax: 512-610-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301078639
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM5396
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberM5396
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM5396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: