Healthcare Provider Details

I. General information

NPI: 1821433871
Provider Name (Legal Business Name): SHILPA MAHENDRA AGRAHARKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 409
BROOKLYN NY
11242-1134
US

IV. Provider business mailing address

523 RUGBY RD
BROOKLYN NY
11226-6505
US

V. Phone/Fax

Practice location:
  • Phone: 929-390-1677
  • Fax:
Mailing address:
  • Phone: 832-545-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number276444
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number04-44830
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number276444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: