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General NPI Number Information
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NPI Number | 1053306530
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Entity Type | Individual
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Provider Name | SHOBHA T. MANI M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 501 SOUTH 54TH STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19143
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Country | US
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Telephone | 215-748-9141
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Fax | 610-789-9937
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Provider Business Mailing Address
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Address Line | 2655 NORTHWINDS PARKWAY
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City | ALPHARETTA
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State | GA
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Zip | 30009
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Country | US
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Telephone | 770-643-5619
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Fax | 678-352-4322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD019336E
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License Number State | PA
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