Healthcare Provider Details

I. General information

NPI: 1992993455
Provider Name (Legal Business Name): BRENDA AIKA SHOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

IV. Provider business mailing address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6700
  • Fax:
Mailing address:
  • Phone: 612-273-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA95027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number62692
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: