Individual
RAVI SHANKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1430 PINE ST, MELBOURNE, FL 32901-3119
(321) 952-0898
(321) 722-1342
Mailing address
PO BOX 534595, ATLANTA, GA 30353-4595
(321) 952-0898
(321) 722-1342
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME#90812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269743200
—
FL
01
—
42918
BLUE CROSS BLUE SHIELD
FL
01
—
P00468588
RR MEDICARE
FL
Enumeration date
07/30/2006
Last updated
06/03/2015
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