Healthcare Provider Details

I. General information

NPI: 1952469769
Provider Name (Legal Business Name): SOUTHERN TIER ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ORCHARD ST
HORNELL NY
14843-2111
US

IV. Provider business mailing address

21 ORCHARD ST
HORNELL NY
14843-2111
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-0061
  • Fax: 607-324-7547
Mailing address:
  • Phone: 607-324-0061
  • Fax: 607-324-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number203720
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number203350
License Number StateNY

VIII. Authorized Official

Name: DR. PRADEEP SHARDA
Title or Position: DIRECTOR
Credential: MD
Phone: 607-324-0061