Provider Demographics
NPI:1588949002
Name:SHANMUGAM, VALLI N (M D)
Entity type:Individual
Prefix:DR
First Name:VALLI
Middle Name:N
Last Name:SHANMUGAM
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 NW 47TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1185
Mailing Address - Country:US
Mailing Address - Phone:352-378-8483
Mailing Address - Fax:
Practice Address - Street 1:3215 NW 47TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1185
Practice Address - Country:US
Practice Address - Phone:352-378-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49293208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice