1669551032 NPI number — MRS. SHOBHA BHIDE

Table of content: MRS. SHOBHA BHIDE (NPI 1669551032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669551032 NPI number — MRS. SHOBHA BHIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHIDE
Provider First Name:
SHOBHA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669551032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 PORPOISE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-453-1644
Provider Business Mailing Address Fax Number:
321-784-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 N ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
COCOA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32931-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-453-1644
Provider Business Practice Location Address Fax Number:
321-784-8212
Provider Enumeration Date:
11/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0003111691 . This is a "ABC IN ORTHOTICS & PROSTH" identifier . This identifiers is of the category "OTHER".




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