Healthcare Provider Details

I. General information

NPI: 1508362781
Provider Name (Legal Business Name): MAHESHWARI BHOGADI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAHESHWARI NALLA DO

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAYSHORE ROAD
NORTH BABYLON NY
11703-2823
US

IV. Provider business mailing address

55 WATER ST FL 2
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 631-586-2700
  • Fax: 631-491-8613
Mailing address:
  • Phone: 718-270-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number334280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: