MEDICARE: SHRUTI ULHAS HEGDE PA-C

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	364SA2200X	Adult Health Clinical Nurse Specialist	15721	MN

General Provider Information

NPI Number	:	1669303616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHRUTI ULHAS HEGDE PA-C

Provider Business Mailing Address
First Line	:	6500 BARRIE RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2306
Country	:	US
Telephone Number	:	952-368-3800
Fax Number	:	952-368-3801

Provider Business Practice Location Address
First Line	:	6500 BARRIE RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2306
Country	:	US
Telephone Number	:	952-368-3800
Fax Number	:	952-368-3801

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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