Provider Demographics
NPI:1417681917
Name:SHETH, JAI UDAY (OD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:UDAY
Last Name:SHETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 E 95TH ST APT 3K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2519
Mailing Address - Country:US
Mailing Address - Phone:973-876-6166
Mailing Address - Fax:
Practice Address - Street 1:2075 BARTOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4613
Practice Address - Country:US
Practice Address - Phone:718-671-5666
Practice Address - Fax:718-862-2306
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist