| Doctor Name: | DR. MANJULA WARAD SHIVPUTRA |
| NPI Number: | 1053660258 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | NYS PERMIT P80993 |
| Business Practice Address: | 17-31 60th Lane Apt #311 Ridgewood, NY - 11385 |
| Business Phone Number: | 3473987787 |
| Business Fax Number: | |
| Mailing Address: | 17-31 60th Lane, Apt #311 RIDGEWOOD |
| State: | NY |
| Postal Code: | 11385 |
| Phone Number: | 3473987787 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2012 |
| NPI Last Update Date: | 09/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | NYS PERMIT P80993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |