Provider Demographics
NPI:1386164226
Name:RAU, SHAKTI AISHWARYA (MD)
Entity type:Individual
Prefix:
First Name:SHAKTI
Middle Name:AISHWARYA
Last Name:RAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAKTI
Other - Middle Name:AISHWARYA
Other - Last Name:NOCHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-738-6611
Practice Address - Fax:401-921-6952
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA293392208600000X, 208600000X
RIMD19345208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery