Basic Information
Provider Information
NPI: 1346271699
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUNSHI
FirstName: ASHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 367 S. GULPH RD
Address2: ATT: IPM CREDENTIALING
City: KING OF PRUSSIA
State: PA
PostalCode: 194063121
CountryCode: US
TelephoneNumber: 7753569393
FaxNumber: 7753565590
Practice Location
Address1: 4647 MANATEE AVE W
Address2:  
City: BRADENTON
State: FL
PostalCode: 342093816
CountryCode: US
TelephoneNumber: 9417455999
FaxNumber: 9417453555
Other Information
ProviderEnumerationDate: 07/05/2006
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME69560FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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