Individual
SHAVETA MANCHANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2115 S FREMONT AVE, SUITE 3000, SPRINGFIELD, MO 65804-2239
(417) 820-9123
(417) 820-3935
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2008029018
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235354259
—
MO
05
—
176933001
—
AR
01
—
431560263
TRICARE WEST
—
Enumeration date
04/16/2007
Last updated
06/18/2009
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