Provider Demographics
NPI:1033157581
Name:SHASTRI, ADITI (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 20TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 W 20TH ST STE 308
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3720
Practice Address - Country:US
Practice Address - Phone:646-929-4149
Practice Address - Fax:347-577-9457
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006094213ES0103X
NY006094213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV07928Medicare UPIN
NYPK4581Medicare ID - Type UnspecifiedEMPIRE