Provider Demographics
NPI:1477648434
Name:SONI, SHASHIBALA (MD FACC FACP)
Entity Type:Individual
Prefix:DR
First Name:SHASHIBALA
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:MD FACC FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4301
Mailing Address - Country:US
Mailing Address - Phone:917-584-8421
Mailing Address - Fax:
Practice Address - Street 1:944 N BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1316
Practice Address - Country:US
Practice Address - Phone:917-942-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128754207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00352878Medicaid
A98088Medicare UPIN
NY05A44ER141Medicare PIN