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General NPI Number Information
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NPI Number | 1861009482
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Entity Type | Individual
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Provider Name | SHIVALI KANAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1720 NICHOLASVILLE RD STE 500
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City | LEXINGTON
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State | KY
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Zip | 40503-1487
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Country | US
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Telephone | 859-278-1114
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Fax | 859-277-0541
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Provider Business Mailing Address
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Address Line | 1221 S BROADWAY
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City | LEXINGTON
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State | KY
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Zip | 40504-2701
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Country | US
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Telephone | 859-258-6200
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Fax | 859-258-6203
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3464
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085009409
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License Number State | IL
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