Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 200101134 | NC |
NPI | 1669456745 |
---|---|
Provider Name | Avinash Kunjan Shetty |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129WG | BCBS (01) | |
2007356000 | (05) | WV |
43324 | PARTNERS (01) | |
440003777 | RR MEDICARE (01) | |
5879639 | (05) | VA |
7687658 | AETNA (01) | |
89129WG | (05) | NC |
B0392 | MEDCOST (01) | |
H44539 | (02) | |
Q0113F | (05) | SC |