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NPI Code Detail

MEDICARE: SYONA SURAJ SHETTY

MEDICARE: SYONA SURAJ SHETTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207RC0000XCardiovascular Disease Physician1083241954MA

General Provider Information

NPI Number : 1083241954
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYONA SURAJ SHETTY
Provider Business Mailing Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 978-289-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2020
Last Update Date : 06/02/2026

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Directions to “ SYONA SURAJ SHETTY ” Practice Location

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