MEDICARE: SHIVANI ANAND BHATT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	062134	NY

General Provider Information

NPI Number	:	1538798194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVANI ANAND BHATT

Provider Business Mailing Address
First Line	:	32 FIRST ST
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-3041
Country	:	US
Telephone Number	:	978-551-5017
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 LOISAIDA AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-6855
Country	:	US
Telephone Number	:	978-551-5017
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	01/13/2022

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Directions to “ SHIVANI ANAND BHATT ” Practice Location

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