Provider Demographics
NPI:1073587325
Name:SHREEDHAR, KAMINI (MD)
Entity Type:Individual
Prefix:
First Name:KAMINI
Middle Name:
Last Name:SHREEDHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-6266
Mailing Address - Fax:845-358-7872
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2221
Practice Address - Country:US
Practice Address - Phone:845-358-6266
Practice Address - Fax:845-358-7872
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173152207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01471489Medicaid
F27891Medicare UPIN
NY01471489Medicaid