Healthcare Provider Details

I. General information

NPI: 1538807177
Provider Name (Legal Business Name): SHILPA MATHEW DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

259 1ST ST
MINEOLA NY
11501-3957
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-8443
  • Fax:
Mailing address:
  • Phone: 516-663-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number339860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: