Provider Demographics
NPI:1598928905
Name:SHENOY, BALKUNJE VITTAL (MD)
Entity Type:Individual
Prefix:
First Name:BALKUNJE
Middle Name:VITTAL
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VITTAL
Other - Middle Name:BALKUNJE
Other - Last Name:SHENOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7036 WHITEMARSH COURT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4901
Mailing Address - Country:US
Mailing Address - Phone:704-552-1669
Mailing Address - Fax:
Practice Address - Street 1:9735 KINCEY AVE STE 201
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9118
Practice Address - Country:US
Practice Address - Phone:704-414-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26369207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology