Individual
SHEM CARLO BANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1220 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3725
(812) 282-6631
Mailing address
1808 HERR LN, LOUISVILLE, KY 40222-6556
(480) 273-5015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10002804A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002804A
STATE LICENSE
IN
Enumeration date
09/17/2019
Last updated
09/17/2019
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