Provider Demographics
NPI:1073709812
Name:DR. SHALINI PATCHA, M.D. P.C.
Entity Type:Organization
Organization Name:DR. SHALINI PATCHA, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-351-5757
Mailing Address - Street 1:96 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2816
Mailing Address - Country:US
Mailing Address - Phone:631-351-5757
Mailing Address - Fax:631-351-5756
Practice Address - Street 1:96 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2816
Practice Address - Country:US
Practice Address - Phone:631-351-5757
Practice Address - Fax:631-351-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1625162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF19939Medicare UPIN
NYW89761Medicare PIN