Provider Demographics
NPI:1215375241
Name:SHETTY, RAJAT (OD)
Entity Type:Individual
Prefix:DR
First Name:RAJAT
Middle Name:
Last Name:SHETTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 HOBART ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1428
Mailing Address - Country:US
Mailing Address - Phone:718-344-1272
Mailing Address - Fax:718-425-9803
Practice Address - Street 1:2556 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2938
Practice Address - Country:US
Practice Address - Phone:718-734-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist