Provider Demographics
NPI:1316043136
Name:PRADHAN, SHILPA R (DO)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:R
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2256
Mailing Address - Country:US
Mailing Address - Phone:484-526-5210
Mailing Address - Fax:610-861-3069
Practice Address - Street 1:1417 8TH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2256
Practice Address - Country:US
Practice Address - Phone:484-526-5210
Practice Address - Fax:610-861-3069
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008095L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708128Medicaid
PA001708128Medicaid
PA276384Medicare ID - Type Unspecified