Provider Demographics
NPI:1083613707
Name:RAYKHER, SHAYA (MD)
Entity Type:Individual
Prefix:
First Name:SHAYA
Middle Name:
Last Name:RAYKHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 AVENUE Z
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3837
Mailing Address - Country:US
Mailing Address - Phone:718-421-9070
Mailing Address - Fax:718-421-9073
Practice Address - Street 1:1400 AVENUE Z
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3837
Practice Address - Country:US
Practice Address - Phone:718-421-9070
Practice Address - Fax:718-421-9073
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01880024Medicaid
NY01880024Medicaid
NYA100000395Medicare PIN