Provider Demographics
NPI:1194919514
Name:INDULKAR, SHALAKA D (MD)
Entity type:Individual
Prefix:DR
First Name:SHALAKA
Middle Name:D
Last Name:INDULKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHALAKA
Other - Middle Name:INDULKAR
Other - Last Name:JAYAWARDENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1133 OFFSHORE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5250
Mailing Address - Country:US
Mailing Address - Phone:718-288-2454
Mailing Address - Fax:910-491-2439
Practice Address - Street 1:1540 PURDUE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5510
Practice Address - Country:US
Practice Address - Phone:910-491-2437
Practice Address - Fax:910-491-2439
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091230208000000X
NC2011-013732084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics