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General NPI Number Information
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NPI Number | 1346378924
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Entity Type | Individual
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Provider Name | SHANTHI RAJENDRAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 05/20/2012
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Provider Practice Location Address
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Address Line | 16 MAIN ST
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City | AKRON
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State | NY
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Zip | 14001-1220
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Country | US
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Telephone | 716-542-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 187 VISCOUNT DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-1771
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Country | US
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Telephone | 716-689-4587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 211182
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License Number State | NY
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