Provider Demographics
NPI:1851356315
Name:SHENOY, NITIN P (MD)
Entity type:Individual
Prefix:MR
First Name:NITIN
Middle Name:P
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:STE 103
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602
Mailing Address - Country:US
Mailing Address - Phone:828-322-1128
Mailing Address - Fax:828-327-9431
Practice Address - Street 1:1771 TATE BLVD SE
Practice Address - Street 2:STE 103
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-322-1128
Practice Address - Fax:828-327-9431
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009701147207R00000X
NC97-01147207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910616Medicaid
NC8910616Medicaid
NC2241847Medicare ID - Type Unspecified