Individual
PRASHANTH SHANMUGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(850) 416-4970
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
(904) 450-6063
(904) 539-4091
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME145475
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118231800
—
FL
Enumeration date
04/15/2017
Last updated
10/04/2024
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