Healthcare Provider Details

I. General information

NPI: 1659684801
Provider Name (Legal Business Name): PRADIP R SHETYE DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 EAST 33RD STREET LOWER LEVEL
NEW YORK NY
10016
US

IV. Provider business mailing address

333 E 30TH ST 15L
NEW YORK NY
10016-6416
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5204
  • Fax: 212-263-4080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number055911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: