Healthcare Provider Details

I. General information

NPI: 1497740344
Provider Name (Legal Business Name): SHEELA EVA HEGDE-BATLIVALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHEELA EVA HEGDE

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2109
  • Fax: 617-789-2066
Mailing address:
  • Phone: 617-789-2109
  • Fax: 617-789-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number203313
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: