Provider Demographics
NPI:1942247341
Name:SHINDE, MINAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MINAKSHI
Middle Name:
Last Name:SHINDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 GLENLAKE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6866
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-626-3237
Practice Address - Street 1:250 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-626-3237
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5869207L00000X
NC02847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153789601Medicaid
TX8G8341OtherBCBS
TX8X6119OtherBCBS
TX8K6931Medicare PIN
TX050089593Medicare PIN
TX8G8341OtherBCBS
TX8X6119OtherBCBS