Healthcare Provider Details

I. General information

NPI: 1366403339
Provider Name (Legal Business Name): RAKESH SHREEDHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LIBERTY SQUARE
STONY POINT NY
10980
US

IV. Provider business mailing address

20 GRAND ST FL 3 CREDENTIALING MANAGER
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-942-0228
  • Fax: 845-942-1519
Mailing address:
  • Phone: 845-987-3906
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number169924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: