Provider Demographics
NPI:1043407059
Name:SACHIN R. SHENOY MD PA
Entity Type:Organization
Organization Name:SACHIN R. SHENOY MD PA
Other - Org Name:NEUROLOGY, HEADACHE AND PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHENOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-264-2011
Mailing Address - Street 1:1845 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2123
Mailing Address - Country:US
Mailing Address - Phone:321-264-2011
Mailing Address - Fax:321-264-0442
Practice Address - Street 1:1845 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2123
Practice Address - Country:US
Practice Address - Phone:321-264-2011
Practice Address - Fax:321-264-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG97132Medicare UPIN
FLK9052Medicare PIN