Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD422605 | PA |
Y | 111NI0900X | Internist | MD422605 | PA |
N | 207RG0300X | Geriatric Medicine | MD422605 | PA |
NPI | 1063476661 |
---|---|
Provider Name | Michele Soraya Shrikanthan |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Plymouth Meeting, PA 19462-2324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 12/05/2020 |