Provider Demographics
NPI:1104235308
Name:KOIRALA PRADHAN, SHANTI (MD)
Entity type:Individual
Prefix:MS
First Name:SHANTI
Middle Name:
Last Name:KOIRALA PRADHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SHANTI
Other - Middle Name:
Other - Last Name:KOIRALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:1955 1ST AVE
Mailing Address - Street 2:ASPEN APT# 721
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6408
Mailing Address - Country:US
Mailing Address - Phone:310-592-9769
Mailing Address - Fax:
Practice Address - Street 1:1955 1ST AVE APT 721
Practice Address - Street 2:ASPEN APT 721
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6446
Practice Address - Country:US
Practice Address - Phone:310-592-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital