Healthcare Provider Details

I. General information

NPI: 1952356545
Provider Name (Legal Business Name): PREETI SHETKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1701
US

IV. Provider business mailing address

439 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1714
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1732
  • Fax: 718-815-3462
Mailing address:
  • Phone: 718-924-2254
  • Fax: 718-442-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: