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General NPI Number Information
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NPI Number | 1164484374
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Entity Type | Individual
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Provider Name | SHONALATHA SUDARSHAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 2101 9TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4133
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Country | US
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Telephone | 940-766-4488
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Fax | 940-322-5765
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Provider Business Mailing Address
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Address Line | 2 PALUXY CIR
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City | WICHITA FALLS
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State | TX
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Zip | 76309-1428
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Country | US
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Telephone | 940-691-5551
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | F7937
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License Number State | TX
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