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Individual

AVINASH KUNJAN SHETTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
200101134
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
129WG
BCBS
05
2007356000
WV
01
43324
PARTNERS
01
440003777
RR MEDICARE
05
5879639
VA
01
7687658
AETNA
05
89129WG
NC
01
B0392
MEDCOST
05
Q0113F
SC
Enumeration date
12/02/2005
Last updated
01/11/2012
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