Provider Demographics
NPI:1346560901
Name:SHERTUKDE BHAKTA, AMOLA (DO)
Entity Type:Individual
Prefix:DR
First Name:AMOLA
Middle Name:
Last Name:SHERTUKDE BHAKTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMOLA
Other - Middle Name:
Other - Last Name:SHERTUKDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1274
Practice Address - Country:US
Practice Address - Phone:617-414-6800
Practice Address - Fax:617-414-6217
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093903AMedicaid
MA110093903AMedicaid