Healthcare Provider Details

I. General information

NPI: 1487315230
Provider Name (Legal Business Name): BINDIA SHETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N CHERRY ST
TULARE CA
93274-2233
US

IV. Provider business mailing address

1134 E CARTMILL AVE BLDG C
TULARE CA
93274
US

V. Phone/Fax

Practice location:
  • Phone: 559-686-9097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: