Provider Demographics
NPI:1568598597
Name:SHINKRE, SHALAKA GANDBHIR (PT)
Entity Type:Individual
Prefix:
First Name:SHALAKA
Middle Name:GANDBHIR
Last Name:SHINKRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHALAKA
Other - Middle Name:SADASHIV
Other - Last Name:GANDBHIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4133 MOHR AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4750
Mailing Address - Country:US
Mailing Address - Phone:925-587-3240
Mailing Address - Fax:925-484-8443
Practice Address - Street 1:4133 MOHR AVE STE F
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4750
Practice Address - Country:US
Practice Address - Phone:925-587-3240
Practice Address - Fax:925-484-8443
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015479225100000X
CA298184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL567700OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP
IL1619908OtherBCBS IL GROUP
ILR00869Medicare PIN