Provider Demographics
NPI:1275327744
Name:KALLARAKAL, SHABANA
Entity type:Individual
Prefix:
First Name:SHABANA
Middle Name:
Last Name:KALLARAKAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2211
Mailing Address - Country:US
Mailing Address - Phone:267-207-7432
Mailing Address - Fax:215-501-5353
Practice Address - Street 1:8105 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2211
Practice Address - Country:US
Practice Address - Phone:267-207-7432
Practice Address - Fax:215-501-5353
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist