Healthcare Provider Details

I. General information

NPI: 1386211639
Provider Name (Legal Business Name): BRINDA BHASKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 FAIRVIEW RD STE 330
CHARLOTTE NC
28210-3260
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-2680
  • Fax: 704-316-2681
Mailing address:
  • Phone: 704-316-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026-03837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: