Healthcare Provider Details

I. General information

NPI: 1417884859
Provider Name (Legal Business Name): SWETTIMUNY MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 OAKDALE ST
STATEN ISLAND NY
10312-5114
US

IV. Provider business mailing address

118 SAINT ANDREWS RD
STATEN ISLAND NY
10306-1510
US

V. Phone/Fax

Practice location:
  • Phone: 929-352-4511
  • Fax: 718-667-2004
Mailing address:
  • Phone: 917-304-5366
  • Fax: 718-667-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SASHI WETTIMUNY
Title or Position: PHYSICIAN
Credential: DO
Phone: 929-352-4511