Provider Demographics
NPI:1457758286
Name:BHADEL, SHRITI (PA-C)
Entity Type:Individual
Prefix:
First Name:SHRITI
Middle Name:
Last Name:BHADEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EASTPARK DR
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7548
Mailing Address - Country:US
Mailing Address - Phone:615-600-4071
Mailing Address - Fax:615-309-8341
Practice Address - Street 1:13299 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7307
Practice Address - Country:US
Practice Address - Phone:562-865-8750
Practice Address - Fax:562-865-8715
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA53391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
538695Medicare PIN