Provider Demographics
NPI:1033299490
Name:PATIL, SHYAM TUKARAM (MD)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:TUKARAM
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 WILBUR ROAD
Mailing Address - Street 2:NEW YORK STATE HVDDSO
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-0470
Mailing Address - Country:US
Mailing Address - Phone:845-947-6220
Mailing Address - Fax:845-947-6240
Practice Address - Street 1:11 WILBUR ROAD
Practice Address - Street 2:NEW YORK STATE HVDDSO
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-0470
Practice Address - Country:US
Practice Address - Phone:845-947-6220
Practice Address - Fax:845-947-6240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-05-28
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Provider Licenses
StateLicense IDTaxonomies
NY153502-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry