Healthcare Provider Details

I. General information

NPI: 1922085976
Provider Name (Legal Business Name): SHARADA JAYAGOPAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HILLSIDE AVE SUITE 301
NEW HYDE PARK NY
11040-2501
US

IV. Provider business mailing address

1575 HILLSIDE AVE SUITE 301
NEW HYDE PARK NY
11040-2501
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-4200
  • Fax: 516-358-2825
Mailing address:
  • Phone: 516-354-4200
  • Fax: 516-358-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number151424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number151424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: