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Individual

SHINY RAJU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ACNP-BC

Contact information

Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 648-9741
(214) 648-9531
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 648-9741
(214) 648-9531

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
603660
TX
363LA2100X
Acute Care Nurse Practitioner
603660
TX

Other

Enumeration date
11/05/2012
Last updated
11/05/2012
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