Healthcare Provider Details

I. General information

NPI: 1295731495
Provider Name (Legal Business Name): PINAKINI SUDHAKAR SHIVDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

201 STATE ST
ERIE PA
16550-0002
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6000
  • Fax: 814-877-6545
Mailing address:
  • Phone: 814-877-6000
  • Fax: 814-877-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD027116E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: