Healthcare Provider Details

I. General information

NPI: 1750670931
Provider Name (Legal Business Name): SIRIKISHAN RAMKISHAN SHETTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SIRI SHETTY

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE FLOOR 11
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE FLOOR 11
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2020
  • Fax: 646-962-0609
Mailing address:
  • Phone: 646-962-2020
  • Fax: 646-962-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number279126-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number279126-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: