Provider Demographics
NPI:1437177011
Name:SHETTY, HEERA S (MD PC)
Entity Type:Individual
Prefix:
First Name:HEERA
Middle Name:S
Last Name:SHETTY
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1309
Mailing Address - Country:US
Mailing Address - Phone:914-969-7100
Mailing Address - Fax:914-969-5028
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-969-7100
Practice Address - Fax:914-969-5028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD91517Medicare UPIN
NY798921Medicare PIN