MEDICARE: SEJAL SHETH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1043095920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEJAL SHETH

Provider Business Mailing Address
First Line	:	3540 82ND ST APT 3H
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5135
Country	:	US
Telephone Number	:	765-409-5280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 82ND ST APT 3H
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5135
Country	:	US
Telephone Number	:	765-409-5280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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Directions to “ SEJAL SHETH ” Practice Location

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