Healthcare Provider Details

I. General information

NPI: 1144311606
Provider Name (Legal Business Name): ROOPALEKHA SHENOY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE MLK JR HEALTH CENTER ,4TH FLOOR
BRONX NY
10457-7606
US

IV. Provider business mailing address

5844 211TH ST
OAKLAND GARDENS NY
11364-1818
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5916
  • Fax: 718-239-8301
Mailing address:
  • Phone: 718-224-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number176260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: