Healthcare Provider Details

I. General information

NPI: 1104765429
Provider Name (Legal Business Name): SHANTI MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 ELM GROVE RD STE 110
ELM GROVE WI
53122-2528
US

IV. Provider business mailing address

890 ELM GROVE RD STE 110
ELM GROVE WI
53122-2528
US

V. Phone/Fax

Practice location:
  • Phone: 262-393-3320
  • Fax: 262-404-8961
Mailing address:
  • Phone: 262-393-3320
  • Fax: 262-404-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HIMANSHU AGRAWAL
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 715-566-0160