MEDICARE: DR. SHILPA DHRUVA TILWALLI M.D.

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
1	2084N0400X	Neurology Physician	65080-20	WI
2	2084N0400X	Neurology Physician	036.118814	IL
3	2084N0400X	Neurology Physician	036118814	IL
4	2084N0400X	Neurology Physician	4301119417	MI
5	2084N0400X	Neurology Physician	25MA09457500	NJ
6	2084N0400X	Neurology Physician	C55889	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036118814	OTHER	IL	PHYSICIAN LICENSE
2	336.080059	OTHER	IL	CONTROLLED SUBSTANCE
3	4301119417	OTHER	MI	BOARD OF MEDICINE
4	C55889	OTHER	CA	THE MEDICAL BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1639339641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHILPA DHRUVA TILWALLI M.D.

Provider Business Mailing Address
First Line	:	7402 HOLLISTER AVE
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2583
Country	:	US
Telephone Number	:	805-562-8686
Fax Number	:	805-456-1796

Provider Business Practice Location Address
First Line	:	7402 HOLLISTER AVE
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2583
Country	:	US
Telephone Number	:	703-675-1375
Fax Number	:	805-456-1796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	12/23/2021

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