Provider Demographics
NPI:1699277830
Name:BHANSARI, SHIKHI
Entity type:Individual
Prefix:
First Name:SHIKHI
Middle Name:
Last Name:BHANSARI
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 1:1926 FAIRVIEW AVE E APT 212
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3649
Mailing Address - Country:US
Mailing Address - Phone:312-659-9644
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2969
Practice Address - Country:US
Practice Address - Phone:503-413-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORDO214842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program