Healthcare Provider Details

I. General information

NPI: 1093030199
Provider Name (Legal Business Name): SHWETA RAINA D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 COLDEN ST APT 10N
FLUSHING NY
11355-5901
US

IV. Provider business mailing address

5213 ROOSEVELT AVE
WOODSIDE NY
11377-8054
US

V. Phone/Fax

Practice location:
  • Phone: 216-272-3447
  • Fax:
Mailing address:
  • Phone: 347-696-4113
  • Fax: 347-696-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: