Provider Demographics
NPI:1225180896
Name:DAFTARY, SWATI MAYUR (MD)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:MAYUR
Last Name:DAFTARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BRECKENRIDGE LN
Mailing Address - Street 2:STE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2798
Mailing Address - Country:US
Mailing Address - Phone:502-495-5055
Mailing Address - Fax:502-495-5057
Practice Address - Street 1:3103 BRECKENRIDGE LN
Practice Address - Street 2:STE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2798
Practice Address - Country:US
Practice Address - Phone:502-495-5055
Practice Address - Fax:502-495-5057
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30614208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64306145Medicaid
F89739Medicare UPIN
KY0919701Medicare ID - Type Unspecified