Provider Demographics
NPI:1043293582
Name:GANDHI, SHAMALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMALA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMALA
Other - Middle Name:
Other - Last Name:PATANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1008
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:2800 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1008
Practice Address - Country:US
Practice Address - Phone:516-622-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152706207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00742810Medicaid
NY83A2YRXP1Medicare PIN
NYC12110Medicare UPIN
NY83A27ZXWW1Medicare PIN
NY83A27ZT5H1Medicare PIN
NY00742810Medicaid
NY83A271Medicare PIN