Provider Demographics
NPI:1275834707
Name:SHINDE, TEJASWINI S
Entity Type:Individual
Prefix:MISS
First Name:TEJASWINI
Middle Name:S
Last Name:SHINDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 VALLEY BROOKE CT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7827
Mailing Address - Country:US
Mailing Address - Phone:813-449-3222
Mailing Address - Fax:
Practice Address - Street 1:1611 VALLEY BROOKE CT
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7827
Practice Address - Country:US
Practice Address - Phone:813-449-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010153742251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics