Individual
DR. REVATHI SHANMUGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
40 EISENHOVER DRIVE, PARAMUS, NJ 07652
(352) 686-2972
Mailing address
123 ABBIE CT, 40 EISENHOWER DRIVE, PARAMUS, NJ 07652
(352) 238-5670
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA08398000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044684000
—
FL
01
—
260037453
RAILROAD MEDICARE
FL
01
—
51265
BC BS OF FL
FL
Enumeration date
10/03/2006
Last updated
07/20/2018
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