Healthcare Provider Details

I. General information

NPI: 1609786714
Provider Name (Legal Business Name): SAMIRA ABHIJIT SHENDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 UNION RD STE A
GASTONIA NC
28054-2201
US

IV. Provider business mailing address

1530 UNION RD STE A
GASTONIA NC
28054-2201
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-6188
  • Fax: 704-866-4437
Mailing address:
  • Phone: 704-867-6188
  • Fax: 704-866-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16876
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: