Healthcare Provider Details

I. General information

NPI: 1992108468
Provider Name (Legal Business Name): SHILPA SOOD M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GRASSLANDS RD SUITE#201
VALHALLA NY
10595-1503
US

IV. Provider business mailing address

503 GRASSLANDS RD SUITE#201
VALHALLA NY
10595-1503
US

V. Phone/Fax

Practice location:
  • Phone: 914-367-0000
  • Fax:
Mailing address:
  • Phone: 914-367-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01071208A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number278652-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: