MEDICARE: MAHADEVAN SHETTY MD

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	2085N0700X	Neuroradiology Physician	020421	CT
2	2085R0202X	Diagnostic Radiology Physician	020421	CT
3	2085U0001X	Diagnostic Ultrasound Physician	020421	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386678290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHADEVAN SHETTY MD

Provider Business Mailing Address
First Line	:	385 MAIN ST S,
Second Line	:	C/O NVRA UNION SQUARE BLDG #1
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-4240
Country	:	US
Telephone Number	:	203-264-7999
Fax Number	:	203-264-7477

Provider Business Practice Location Address
First Line	:	385 MAIN ST S,
Second Line	:	C/O NVRA UNION SQUARE BLDG#1
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-4240
Country	:	US
Telephone Number	:	203-264-7999
Fax Number	:	203-264-7477

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/18/2010

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Directions to “ MAHADEVAN SHETTY MD” Practice Location

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