Provider Demographics
NPI:1033632336
Name:ULLIKASHI, SHILPA MOHAN (MD)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:MOHAN
Last Name:ULLIKASHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E FLORENCE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4765
Mailing Address - Country:US
Mailing Address - Phone:520-374-6505
Mailing Address - Fax:520-374-6501
Practice Address - Street 1:1760 E FLORENCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4765
Practice Address - Country:US
Practice Address - Phone:520-374-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70172-20208000000X
WI390200000X
AZ73510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program