Provider Demographics
NPI:1528155132
Name:THIRUMALAI, SHANTI SENGAMALAM (MD)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:SENGAMALAM
Last Name:THIRUMALAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:75 PRINGLE WAY STE 505
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1469
Practice Address - Country:US
Practice Address - Phone:757-982-5437
Practice Address - Fax:775-982-3971
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME997912080P0008X
NV244522084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A530600 L59OtherCAL OPTIMA
MI4948191Medicaid
CA00A530600Medicaid
CAWA53060AMedicare ID - Type Unspecified
MI0P22900002Medicare PIN
CA00A530600 L59OtherCAL OPTIMA