Healthcare Provider Details

I. General information

NPI: 1912636390
Provider Name (Legal Business Name): SHREYAN MOHAPATRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROE AVENUE ARNOT OGDEN MEDICAL CENTER
ELMIRA NY
14905
US

IV. Provider business mailing address

600 ROE AVENUE ARNOT OGDEN MEDICAL CENTER
ELMIRA NY
14905
US

V. Phone/Fax

Practice location:
  • Phone: 607-442-1713
  • Fax: 607-873-7359
Mailing address:
  • Phone: 607-442-1713
  • Fax: 607-873-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number338950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: