Healthcare Provider Details

I. General information

NPI: 1346709136
Provider Name (Legal Business Name): SHIVANY PATHANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-8111
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4660
  • Fax: 401-444-6045
Mailing address:
  • Phone: 631-444-8115
  • Fax: 631-444-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number338549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: