Healthcare Provider Details

I. General information

NPI: 1669303616
Provider Name (Legal Business Name): SHRUTI ULHAS HEGDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BARRIE RD
EDINA MN
55435-2306
US

IV. Provider business mailing address

6500 BARRIE RD
EDINA MN
55435-2306
US

V. Phone/Fax

Practice location:
  • Phone: 952-368-3800
  • Fax: 952-368-3801
Mailing address:
  • Phone: 952-368-3800
  • Fax: 952-368-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15721
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: