Provider Demographics
NPI:1487371779
Name:RABINDRANATH SHANKER, UDAYANI UMA (PA-C)
Entity type:Individual
Prefix:MS
First Name:UDAYANI
Middle Name:UMA
Last Name:RABINDRANATH SHANKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WALLABOUT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7830
Mailing Address - Country:US
Mailing Address - Phone:718-260-4600
Mailing Address - Fax:
Practice Address - Street 1:74 WALLABOUT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-7830
Practice Address - Country:US
Practice Address - Phone:718-260-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant