Healthcare Provider Details

I. General information

NPI: 1790149656
Provider Name (Legal Business Name): SHRIDEVI SINGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 11/16/2025
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEACH DR
WEST ISLIP NY
11795-4929
US

IV. Provider business mailing address

111 BEACH DR
WEST ISLIP NY
11795-4929
US

V. Phone/Fax

Practice location:
  • Phone: 631-417-8643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number322332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: