Provider Demographics
NPI:1053306530
Name:MANI, SHOBHA T (MD)
Entity type:Individual
Prefix:
First Name:SHOBHA
Middle Name:T
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHOBHA
Other - Middle Name:SUSAN
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 NORTHWINDS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:770-643-5619
Mailing Address - Fax:678-352-4322
Practice Address - Street 1:501 SOUTH 54TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:215-748-9141
Practice Address - Fax:610-789-9937
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019336E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA408097H12Medicare PIN