Provider Demographics
NPI:1194910695
Name:SHANBHAG, VIKRAM SHARAD (MSPT)
Entity type:Individual
Prefix:MR
First Name:VIKRAM
Middle Name:SHARAD
Last Name:SHANBHAG
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ANDREW AVE
Mailing Address - Street 2:APT # 272
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4356
Mailing Address - Country:US
Mailing Address - Phone:203-843-3550
Mailing Address - Fax:
Practice Address - Street 1:151 ANDREW AVE
Practice Address - Street 2:APT # 272
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4356
Practice Address - Country:US
Practice Address - Phone:203-843-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012956225100000X
CT008046225100000X
IN05009140A225100000X
PAPT018527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist