Provider Demographics
NPI:1477864379
Name:SHINDE, ANITA B (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:B
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 1:3540 STUART CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7737
Mailing Address - Country:US
Mailing Address - Phone:609-350-3666
Mailing Address - Fax:
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:STE 9
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-574-5864
Practice Address - Fax:239-574-1451
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107456207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149H9OtherBC/BS
FL002612000Medicaid
FL149H9OtherBC/BS