Provider Demographics
NPI:1285703157
Name:BHATTACHARYYA, SHIBANI (MD)
Entity type:Individual
Prefix:DR
First Name:SHIBANI
Middle Name:
Last Name:BHATTACHARYYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11152 W MEINECKE AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1251
Mailing Address - Country:US
Mailing Address - Phone:804-878-0278
Mailing Address - Fax:
Practice Address - Street 1:11152 W MEINECKE AVE
Practice Address - Street 2:APT #2
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1251
Practice Address - Country:US
Practice Address - Phone:804-878-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08621800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology