Provider Demographics
NPI:1417234519
Name:SHINDE, SUBRAO PANDA
Entity Type:Individual
Prefix:MR
First Name:SUBRAO
Middle Name:PANDA
Last Name:SHINDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1072
Mailing Address - Country:US
Mailing Address - Phone:877-469-3778
Mailing Address - Fax:866-721-4334
Practice Address - Street 1:7147 CURTISS AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8012
Practice Address - Country:US
Practice Address - Phone:941-921-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist