Individual
SHANTI MANGALASSERIL SHIVAJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
510 N ELAM AVE STE 101, GREENSBORO, NC 27403-1135
(336) 854-8800
(336) 834-0595
Mailing address
1730 BALDWIN DR, MC LEAN, VA 22101-5048
(703) 442-0486
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
202002975
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2016
Last updated
07/06/2020
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