Provider Demographics
NPI:1588664239
Name:SHASHIDHARAN, MANIAMPARAMPIL (MBBS)
Entity type:Individual
Prefix:
First Name:MANIAMPARAMPIL
Middle Name:
Last Name:SHASHIDHARAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 NICHOLAS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2186
Mailing Address - Country:US
Mailing Address - Phone:402-343-1122
Mailing Address - Fax:402-343-1177
Practice Address - Street 1:9850 NICHOLAS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2186
Practice Address - Country:US
Practice Address - Phone:402-343-1122
Practice Address - Fax:402-343-1177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20913208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47053395013Medicaid
NE47053395014Medicaid
NE47053395014Medicaid
NE274210Medicare ID - Type Unspecified