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NPI Code Detail

MEDICARE: SHABNAM A FIDVI M.D.

MEDICARE: SHABNAM A FIDVI M.D.
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
12085R0202XDiagnostic Radiology Physician002181NY

General Provider Information

NPI Number : 1477552065
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHABNAM A FIDVI M.D.
Provider Business Mailing Address
First Line : 244 WESTCHESTER AVE
Second Line : STE 103
City : WHITE PLAINS
State : NY
Zip : 10604-2907
Country : US
Telephone Number : 914-872-2502
Fax Number : 914-782-2470
Provider Business Practice Location Address
First Line : 761 N BROADWAY
Second Line :
City : SLEEPY HOLLOW
State : NY
Zip : 10591-1020
Country : US
Telephone Number : 914-366-3450
Fax Number : 914-366-1514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/08/2007

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