Provider Demographics
NPI:1871084160
Name:GANDHI, SHANA (DPM)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:350 N MAIN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1635
Practice Address - Country:US
Practice Address - Phone:734-433-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY269182213E00000X
MI5901002801213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist