Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 01065061A | IN |
Y | 207RP1001X | Pulmonary Disease | 01065061A | IN |
N | 207RP1001X | Pulmonary Disease | 036101710 | IL |
N | 207RS0012X | Sleep Medicine | 01065061A | IN |
NPI | 1013073543 |
---|---|
Provider Name | Shalini K Manchanda |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 24/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000576504 | ANTHEM (01) | IN |
200412190 | (05) | IN |
F04500 | (02) | IL |