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General NPI Number Information
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NPI Number | 1326104894
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Entity Type | Individual
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Provider Name | MANISHA CHANDRAKANT SHANBHAG MD
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR STE A200
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City | GREENVILLE
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State | SC
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Zip | 29615-3580
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Country | US
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Telephone | 864-454-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34098
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 34098
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number | 34098
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License Number State | SC
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