Provider Demographics
NPI:1821865742
Name:PETE PRASHAMSA SHENOY, FNU (MD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:PETE PRASHAMSA SHENOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PETE PRASHAMSA
Other - Middle Name:
Other - Last Name:SHENOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1301 N HARRISON ST APT 1105
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST STE 701
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-503-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481561207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1851889836Medicaid