Provider Demographics
NPI:1659472124
Name:SHINDE, MANOHAR SAMBHAJI (MD PHD)
Entity Type:Individual
Prefix:MR
First Name:MANOHAR
Middle Name:SAMBHAJI
Last Name:SHINDE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 SAN FERNANDO ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3624
Mailing Address - Country:US
Mailing Address - Phone:818-956-0101
Mailing Address - Fax:818-956-1413
Practice Address - Street 1:6425 SAN FERNANDO ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3624
Practice Address - Country:US
Practice Address - Phone:818-956-0101
Practice Address - Fax:818-956-1413
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 345972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7997816Medicaid
CA7997816Medicaid
A84658Medicare UPIN