Provider Demographics
NPI:1144292004
Name:SHANBHAG, SUHAS (MD)
Entity type:Individual
Prefix:
First Name:SUHAS
Middle Name:
Last Name:SHANBHAG
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:PO BOX 7500
Mailing Address - Street 2:SULLIVAN WAY
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-633-1502
Mailing Address - Fax:
Practice Address - Street 1:SULLIVAN WAY
Practice Address - Street 2:TRENTON PSYCHIATRIC HOSPITAL
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-633-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA697962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8764808Medicaid
NJ8764808Medicaid
NJB13565Medicare UPIN