Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 7456 | SD |
NPI | 1053582270 |
---|---|
Provider Name | Mark Shashikant |
First Address | Sioux Falls, SD 57118-6430 |
Second Address | Sioux Falls, SD 57108-8589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2008 |
Last Update Date | 06/05/2016 |