Provider Demographics
NPI: | 1851356315 |
---|---|
Name: | SHENOY, NITIN P (MD) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | NITIN |
Middle Name: | P |
Last Name: | SHENOY |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1771 TATE BLVD SE |
Mailing Address - Street 2: | STE 103 |
Mailing Address - City: | HICKORY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-322-1128 |
Mailing Address - Fax: | 828-327-9431 |
Practice Address - Street 1: | 1771 TATE BLVD SE |
Practice Address - Street 2: | STE 103 |
Practice Address - City: | HICKORY |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28602 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-322-1128 |
Practice Address - Fax: | 828-327-9431 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-19 |
Last Update Date: | 2012-05-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 009701147 | 207R00000X |
NC | 97-01147 | 207RS0012X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8910616 | Medicaid | |
NC | 8910616 | Medicaid | |
NC | 2241847 | Medicare ID - Type Unspecified |