Provider Demographics
NPI:1982910246
Name:SHINGAVI, AMOLKUMAR
Entity Type:Individual
Prefix:
First Name:AMOLKUMAR
Middle Name:
Last Name:SHINGAVI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 PEBBLE BEACH DR
Mailing Address - Street 2:PINE VALLEY APT
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6480
Mailing Address - Country:US
Mailing Address - Phone:862-579-5248
Mailing Address - Fax:
Practice Address - Street 1:1600 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4804
Practice Address - Country:US
Practice Address - Phone:410-836-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist