Provider Demographics
NPI:1598901431
Name:SHANBHAG, SUJATA MADHUKAR (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:MADHUKAR
Last Name:SHANBHAG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10 CENTER DRIVE, BLDG 10
Mailing Address - Street 2:ROOM B1D-416, MSC-1061
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1061
Mailing Address - Country:US
Mailing Address - Phone:301-496-3658
Mailing Address - Fax:301-896-7521
Practice Address - Street 1:10 CENTER DRIVE, BLDG 10
Practice Address - Street 2:ROOM B1D-416, MSC-1061
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1061
Practice Address - Country:US
Practice Address - Phone:301-496-3658
Practice Address - Fax:301-896-7521
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0065619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease