MEDICARE: SWETTIMUNY MEDICAL, PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1417884859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWETTIMUNY MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	118 SAINT ANDREWS RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1510
Country	:	US
Telephone Number	:	917-304-5366
Fax Number	:	718-667-2004

Provider Business Practice Location Address
First Line	:	346 OAKDALE ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5114
Country	:	US
Telephone Number	:	929-352-4511
Fax Number	:	718-667-2004

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SASHI WETTIMUNY
Credential	:	DO
Telephone Number	:	929-352-4511

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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