Basic Information
Provider Information
NPI: 1003009838
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIMHA
FirstName: SHRUTI
MiddleName: VIJAYA
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.P.H
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 301 E WENDOVER AVE
Address2: STE 400
City: GREENSBORO
State: NC
PostalCode: 274011230
CountryCode: US
TelephoneNumber: 3368323150
FaxNumber:  
Practice Location
Address1: 301 E WENDOVER AVE
Address2: STE 400
City: GREENSBORO
State: NC
PostalCode: 274011230
CountryCode: US
TelephoneNumber: 3368323150
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/24/2007
LastUpdateDate: 04/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X2007-01338NCY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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