Provider Demographics
NPI:1215261987
Name:SHIVARAM, PRASHANTI (PA)
Entity type:Individual
Prefix:MRS
First Name:PRASHANTI
Middle Name:
Last Name:SHIVARAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8278
Mailing Address - Country:US
Mailing Address - Phone:414-425-8232
Mailing Address - Fax:414-425-8267
Practice Address - Street 1:7400 W RAWSON AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8278
Practice Address - Country:US
Practice Address - Phone:414-425-8232
Practice Address - Fax:414-425-8267
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2467-023363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical