Provider Demographics
NPI:1669551032
Name:BHIDE, SHOBHA
Entity type:Individual
Prefix:MRS
First Name:SHOBHA
Middle Name:
Last Name:BHIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 PORPOISE ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5644
Mailing Address - Country:US
Mailing Address - Phone:321-453-1644
Mailing Address - Fax:321-784-8212
Practice Address - Street 1:1485 N ATLANTIC AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3244
Practice Address - Country:US
Practice Address - Phone:321-453-1644
Practice Address - Fax:321-784-8212
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003111691OtherABC IN ORTHOTICS & PROSTH