Provider Demographics
NPI:1861407421
Name:SHANKAR, RAVI (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:M
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 534595
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4595
Mailing Address - Country:US
Mailing Address - Phone:321-952-0898
Mailing Address - Fax:321-722-1342
Practice Address - Street 1:1430 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3119
Practice Address - Country:US
Practice Address - Phone:321-952-0898
Practice Address - Fax:321-722-1342
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME#908122085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269743200Medicaid
FL42918OtherBLUE CROSS BLUE SHIELD
FLP00468588OtherRR MEDICARE
FL42918OtherBLUE CROSS BLUE SHIELD
FL42918XMedicare PIN
FL42918YMedicare PIN