Provider Demographics
NPI:1750944716
Name:SHETE, KANHA CHARUDUTT (MM, BSC)
Entity type:Individual
Prefix:
First Name:KANHA
Middle Name:CHARUDUTT
Last Name:SHETE
Suffix:
Gender:M
Credentials:MM, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST.
Mailing Address - Street 2:GME OFFICE WESTERLY SUITE 'C'
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92534-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4196
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST.
Practice Address - Street 2:GME OFFICE WESTERLY SUITE 'C'
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92534-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS300-503-92-204-0OtherDRIVERS LICENSE