Healthcare Provider Details

I. General information

NPI: 1437484391
Provider Name (Legal Business Name): SHALEEN AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE UNIVERSITY OF ROCHESTER MEDICAL CENTER
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

3 W SQUIRE DR APT # 5
ROCHESTER NY
14623-1725
US

V. Phone/Fax

Practice location:
  • Phone: 585-694-4043
  • Fax:
Mailing address:
  • Phone: 585-694-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberP73115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: