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NPI Code Detail

MEDICARE: NAGARAKERE SHANKARAIAH MD

MEDICARE: NAGARAKERE SHANKARAIAH 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
1208000000XPediatrics PhysicianME57808FL

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 : 1588636450
Entity Type Code : Organization
Provider Name (Legal Business Name) : NAGARAKERE SHANKARAIAH MD
Provider Business Mailing Address
First Line : 3112 S CONGRESS AVE
Second Line : STE A
City : PALM SPRINGS
State : FL
Zip : 33461
Country : US
Telephone Number : 561-964-0110
Fax Number : 561-964-0401
Provider Business Practice Location Address
First Line : 3112 S CONGRESS AVE
Second Line : STE A
City : PALM SPRINGS
State : FL
Zip : 33461
Country : US
Telephone Number : 561-964-0110
Fax Number : 561-964-0401
Authorized Official
Title or Position : ADMINISTRATOR
Name : NAGARAKERE SHANKARAIAH
Credential : MD
Telephone Number : 561-964-0110
Provider Enumeration Date : 02/06/2006
Last Update Date : 08/22/2020

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