Provider Demographics
NPI:1235207945
Name:MAINA R SHETTY MD INC
Entity Type:Organization
Organization Name:MAINA R SHETTY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAINA
Authorized Official - Middle Name:RAVI
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-782-7111
Mailing Address - Street 1:27206 CALAROGA AVE
Mailing Address - Street 2:203
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545
Mailing Address - Country:US
Mailing Address - Phone:510-782-7111
Mailing Address - Fax:510-782-7649
Practice Address - Street 1:27206 CALAROGA AVE
Practice Address - Street 2:203
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545
Practice Address - Country:US
Practice Address - Phone:510-782-7111
Practice Address - Fax:510-782-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A516890Medicare ID - Type Unspecified
G08111Medicare UPIN