Provider Demographics
NPI:1174679807
Name:SHRIDHARANI, SACHIN MAHAVIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:MAHAVIR
Last Name:SHRIDHARANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 5TH AVE
Mailing Address - Street 2:SUITE 1ABCD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:816-668-9092
Mailing Address - Fax:
Practice Address - Street 1:880 5TH AVE
Practice Address - Street 2:SUITE 1ABCD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:816-668-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAJ4147357208200000X
NY269516-01208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery