Individual
SUKIRTI BISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2295 E 14TH ST STE 100, WINSTON SALEM, NC 27105-6804
(336) 713-8860
(336) 713-8862
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2017-00991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385283
—
SC
01
—
SC76947477
MEDICARE
SC
Enumeration date
08/20/2011
Last updated
11/02/2017
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