Provider Demographics
NPI:1588783567
Name:PRABHAKARAN, SHAHI KRISHNAN (MSN)
Entity type:Individual
Prefix:MR
First Name:SHAHI
Middle Name:KRISHNAN
Last Name:PRABHAKARAN
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 BEL PRE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853
Mailing Address - Country:US
Mailing Address - Phone:301-442-0908
Mailing Address - Fax:
Practice Address - Street 1:4313 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853
Practice Address - Country:US
Practice Address - Phone:301-442-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN57971363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner