MEDICARE: SHARDENDU MISHRA MBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1497647283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARDENDU MISHRA MBBS

Provider Business Mailing Address
First Line	:	3650 GETTYSBURG AVE S APT 73
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3788
Country	:	US
Telephone Number	:	434-249-2774
Fax Number	:	434-249-2774

Provider Business Practice Location Address
First Line	:	3650 GETTYSBURG AVE S APT 73
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3788
Country	:	US
Telephone Number	:	434-249-2774
Fax Number	:	434-249-2774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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