Provider Demographics
NPI:1215271390
Name:RAVINDRAN, SHASHI BALA (MPH, MSN, CRNP)
Entity type:Individual
Prefix:
First Name:SHASHI
Middle Name:BALA
Last Name:RAVINDRAN
Suffix:
Gender:F
Credentials:MPH, MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLOISTER CT BLDG 60
Mailing Address - Street 2:ROOM 259
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-4733
Mailing Address - Country:US
Mailing Address - Phone:301-496-3859
Mailing Address - Fax:
Practice Address - Street 1:1 CLOISTER CT BLDG 60
Practice Address - Street 2:ROOM 259
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-4733
Practice Address - Country:US
Practice Address - Phone:301-496-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR104921363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health