MEDICARE: NAGARAKERE R SHANKARAIAH 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	208000000X	Pediatrics Physician	ME57808	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1801995535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGARAKERE R SHANKARAIAH M.D.

Provider Business Mailing Address
First Line	:	3112 S CONGRESS AVE
Second Line	:	SUITE 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	:	SUITE 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	11/17/2011

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