Basic Information
| Provider Information | |||||||||
| NPI: | 1265886592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODARA | ||||||||
| FirstName: | SHEFALI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | HOUSE NUMBER 1217 | ||||||||
| Address2: | SECTOR-14P | ||||||||
| City: | HISAR | ||||||||
| State: | HARYANA | ||||||||
| PostalCode: | 125001 | ||||||||
| CountryCode: | IN | ||||||||
| TelephoneNumber: | 0917056919690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | 9C- UHC | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455146 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2016 | ||||||||
| LastUpdateDate: | 04/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.