MEDICARE: DR. SHIRLEY M MADHERE 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	208200000X	Plastic Surgery Physician	218654	NY

General Provider Information

NPI Number	:	1609985787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY M MADHERE MD

Provider Business Mailing Address
First Line	:	14361 227TH ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-3539
Country	:	US
Telephone Number	:	212-941-1571
Fax Number	:	212-994-8083

Provider Business Practice Location Address
First Line	:	594 BROADWAY RM 204
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-3234
Country	:	US
Telephone Number	:	212-941-1571
Fax Number	:	212-941-8083

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/21/2021

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