Provider Demographics
NPI:1093030199
Name:RAINA, SHWETA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHWETA
Middle Name:
Last Name:RAINA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8054
Mailing Address - Country:US
Mailing Address - Phone:347-696-4113
Mailing Address - Fax:347-696-4113
Practice Address - Street 1:4323 COLDEN ST
Practice Address - Street 2:APT 10N
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5901
Practice Address - Country:US
Practice Address - Phone:216-272-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006638213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04451667Medicaid