Provider Demographics
NPI:1578029955
Name:SHINDE, KIRSTEN THERESA (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:THERESA
Last Name:SHINDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:THERESA
Other - Last Name:NEDDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:684 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1405
Mailing Address - Country:US
Mailing Address - Phone:401-434-0022
Mailing Address - Fax:401-434-6111
Practice Address - Street 1:684 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1405
Practice Address - Country:US
Practice Address - Phone:401-434-0022
Practice Address - Fax:401-434-6111
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01263363A00000X, 363A00000X
MAPENDING363A00000X
MAPA6932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant