Individual
DR. DIVYA SHAKTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5250
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301090267
MI
2080P0202X
Pediatric Cardiology Physician
Primary
23419
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05487537
—
MS
01
—
998912
DMC EMPLOYEE ID NUMBER
MI
Enumeration date
02/05/2008
Last updated
07/21/2022
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