Provider Demographics
NPI:1306942776
Name:MENDIRATTA, SHAM S (MD)
Entity type:Individual
Prefix:DR
First Name:SHAM
Middle Name:S
Last Name:MENDIRATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2747 CRESCENT ST
Mailing Address - Street 2:203
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3142
Mailing Address - Country:US
Mailing Address - Phone:718-721-1800
Mailing Address - Fax:718-721-3004
Practice Address - Street 1:2747 CRESCENT ST
Practice Address - Street 2:203
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-3142
Practice Address - Country:US
Practice Address - Phone:718-721-1800
Practice Address - Fax:718-721-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1099802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology