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NPI Code Detail

MEDICARE: MS. SHANMUGAN SHANTHA MD

MEDICARE: MS. SHANMUGAN SHANTHA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianMD150RLA
22084P0800XPsychiatry PhysicianMD.15098RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255341798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANMUGAN SHANTHA MD
Provider Business Mailing Address
First Line : 7153 EDGEWATER DR
Second Line :
City : MANDEVILLE
State : LA
Zip : 70471-7431
Country : US
Telephone Number : 504-914-2908
Fax Number : 504-349-1668
Provider Business Practice Location Address
First Line : 900 WILKINSON ST
Second Line :
City : MANDEVILLE
State : LA
Zip : 70448-3533
Country : US
Telephone Number : 985-624-4450
Fax Number : 985-624-4451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 01/31/2024

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