NPIMap

Organization Active NPI

Radovi LLC

  • Psychiatry Physician
  • Mandeville, LA
National Provider Identifier
1619228509
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
15098R Issued in LA
Legal business name
RADOVI LLC
Practice address
7153 Edgewater Dr
Mandeville, LA 70471-7431
Phone
(504) 914-2908
Fax
(985) 674-4390
NPI assigned
Oct 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

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

Authorized official

Name
Dr. Shanmuganathan Shantha, M.D
Title
Direct Owner
Phone
(504) 914-2908

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 15098R LA Primary

Addresses

Primary practice location

7153 Edgewater Dr
Mandeville, LA 70471-7431

Mailing address

7153 Edgewater Dr
Mandeville, LA 70471-7431
Phone (504) 914-2908

Other identifiers 1

IdentifierTypeStateIssuer
1422029MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1619228509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7153 EDGEWATER DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704717431",
            "telephone_number": "504-914-2908",
            "fax_number": "985-674-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7153 EDGEWATER DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704717431",
            "telephone_number": "504-914-2908",
            "fax_number": "985-674-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADOVI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "SHANTHA",
        "authorized_official_first_name": "SHANMUGANATHAN",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "504-914-2908",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "15098R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1422029",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.