Provider Demographics
NPI:1316350663
Name:SHANBHAG, PRATIMA RAMESH (MD)
Entity type:Individual
Prefix:
First Name:PRATIMA
Middle Name:RAMESH
Last Name:SHANBHAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:MLC 3008
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-803-1178
Mailing Address - Fax:513-636-0204
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:MAYERSON CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-7233
Practice Address - Fax:407-872-0544
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN20214390200000X
OH35.131142208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program