Provider Demographics
NPI:1376269332
Name:VAIDYA, SHIVANI KISHOR
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:KISHOR
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEW YORK PLZ STE L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1901
Mailing Address - Country:US
Mailing Address - Phone:646-886-8687
Mailing Address - Fax:212-656-1091
Practice Address - Street 1:1 NEW YORK PLZ STE L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1901
Practice Address - Country:US
Practice Address - Phone:646-886-8687
Practice Address - Fax:212-656-1091
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist