Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 200200957 | NC |
N | 208000000X | Pediatrician | 35241 | AZ |
N | 2080P0202X | Pediatric Cardiologist | 35241 | AZ |
N | 2080P0203X | Pediatric Critical Care Doctor | 35241 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD2021-0925 | NM |
NPI | 1215982889 |
---|---|
Provider Name | Dr. Sharad Parakkal Menon |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 15/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124706 | (05) | AZ |
89135NY | (05) | NC |
G98963 | (02) |