Healthcare Provider Details

I. General information

NPI: 1548725104
Provider Name (Legal Business Name): SHIRLY RAMCHANDANI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 07/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEVINS ST STE 304
BRIGHTON MA
02135-3514
US

IV. Provider business mailing address

11 NEVINS ST STE 304
BRIGHTON MA
02135-3514
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-0500
  • Fax: 617-562-0600
Mailing address:
  • Phone: 617-562-0500
  • Fax: 617-562-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIRLY RAMCHANDANI
Title or Position: PHYSICIAN
Credential: MD
Phone: 671-562-0500