Provider Demographics
NPI:1972978153
Name:GANTI, SHANKAR UMA (MD)
Entity type:Individual
Prefix:
First Name:SHANKAR
Middle Name:UMA
Last Name:GANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1110
Mailing Address - Country:US
Mailing Address - Phone:914-484-6144
Mailing Address - Fax:
Practice Address - Street 1:20 WILLOW LN
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1110
Practice Address - Country:US
Practice Address - Phone:914-484-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156993-1208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine