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General NPI Number Information
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NPI Number | 1194919514
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Entity Type | Individual
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Provider Name | SHALAKA D INDULKAR M.D
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 1540 PURDUE DR STE 101
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5510
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Country | US
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Telephone | 910-491-2437
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Fax | 910-491-2439
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Provider Business Mailing Address
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Address Line | 1133 OFFSHORE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5250
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Country | US
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Telephone | 718-288-2454
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Fax | 910-491-2439
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35091230
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 2011-01373
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License Number State | NC
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