{
"Npi": {
"NPI": "1396971925",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHIVDAT-NANHOE",
"FirstName": "ROSITA",
"MiddleName": "SADHANA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NANHOE",
"OtherFirstName": "ROSITA",
"OtherMiddleName": "SADHANA",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "116 HOSPITAL DR",
"SecondLineMailingAddress": "STE A",
"MailingAddressCityName": "WARNER ROBINS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31088-4204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-733-6803",
"MailingAddressFaxNumber": "478-225-2477",
"FirstLinePracticeLocationAddress": "116A HOSPITAL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARNER ROBINS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31088-4204",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-225-2297",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/10/2009",
"LastUpdateDate": "12/16/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084N0600X",
"TaxonomyName": "Clinical Neurophysiology Physician",
"LicenseNumber": "62081",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "62081",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}