Revathi Shanmugham, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA08398000 Issued in NJ

Practice address

40 Eisenhover Drive
Paramus, NJ 07652

Phone

(352) 686-2972

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532044800000",
    "number": "1457445033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 ABBIE CT",
            "address_2": "40 EISENHOWER DRIVE",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "07652",
            "telephone_number": "352-238-5670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 EISENHOVER DRIVE",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "07652",
            "telephone_number": "352-686-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANMUGHAM",
        "first_name": "REVATHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2018-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA08398000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260037453",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF FL",
            "identifier": "51265",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044684000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Viral Jagdishbhai Shah, M.D.
• Khashayar Shakiba, MD
• Fnu Shamail Ahmed
• Amin Shamal, M.D.
• Rachel Anne Shamash, D.D.S.
• Emily Shapiro
• Brownita Akimah Sharif
• Agratta Sharma, MD
• Puneeta Sharma, M.D.
• David Edward Sharp, MD

• Psychiatry Physician in Paramus, NJ
• Providers in Paramus, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.