Provider Demographics
NPI:1376676577
Name:BAGAI, SHVETA (PT)
Entity Type:Individual
Prefix:
First Name:SHVETA
Middle Name:
Last Name:BAGAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NEIL CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5815
Mailing Address - Country:US
Mailing Address - Phone:516-745-8050
Mailing Address - Fax:
Practice Address - Street 1:15 NEIL CT
Practice Address - Street 2:INSIDE JCC
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5815
Practice Address - Country:US
Practice Address - Phone:516-766-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027889-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ30N91Medicare PIN