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General NPI Number Information
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NPI Number | 1336221696
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Entity Type | Organization
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Legal Business Name | SHYAM C. SHIVDASANI, MD INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 140 LOCKWOOD AVE SUITE #216
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-4915
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Country | US
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Telephone | 914-235-6900
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Fax | 914-235-7900
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Provider Business Mailing Address
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Address Line | 21 RENI RD
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City | MANHASSET
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State | NY
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Zip | 11030-1222
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Country | US
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Telephone | 516-869-3210
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Fax | 516-627-0464
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Authorized Official
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Title or Position | VP
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Name | MS. SHALEEN MAKHIJANI SHIVDASANI
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Credential | CPA
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Telephone | 516-242-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 196192
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 196192
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License Number State | NY
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