Provider Demographics
NPI:1770946246
Name:HENDERSHOT, WADE (DPM)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:HENDERSHOT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARDEN PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-5257
Mailing Address - Country:US
Mailing Address - Phone:831-443-6050
Mailing Address - Fax:
Practice Address - Street 1:110 HARDEN PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5257
Practice Address - Country:US
Practice Address - Phone:831-443-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6183213ES0103X
NV2050213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2050OtherNV PODIATRY LICENSE
NV1770946246Medicaid