Provider Demographics
NPI:1376682245
Name:PATHY, SHEFALI RAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEFALI
Middle Name:RAM
Last Name:PATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHEFALI
Other - Middle Name:RAM
Other - Last Name:PARDANANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2419
Mailing Address - Country:US
Mailing Address - Phone:203-621-3700
Mailing Address - Fax:203-332-0376
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-621-3700
Practice Address - Fax:203-332-0376
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233622207V00000X
CT045738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02665603Medicaid
CT004234788Medicaid