Provider Demographics
NPI:1346378924
Name:RAJENDRAN, SHANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTHI
Middle Name:
Last Name:RAJENDRAN
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 1:187 VISCOUNT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1771
Mailing Address - Country:US
Mailing Address - Phone:716-689-4587
Mailing Address - Fax:
Practice Address - Street 1:16 MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-1220
Practice Address - Country:US
Practice Address - Phone:716-542-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020552502OtherUNIVERA
NY000525581003OtherBLUECROSS BLUE SHIELD
NY01991253Medicaid
NY0110623OtherINDEPENDENT HEALTH
NY161601272OtherAETNA
NY102966BFOtherPREFERRED HEALTH
NY040426035673OtherFIDELIS CARE NEWYORK
NY161601272OtherCIGNA
NY161601272OtherUNITED
NY102966BFOtherPREFERRED HEALTH
NY040426035673OtherFIDELIS CARE NEWYORK