Provider Demographics
NPI:1497740344
Name:HEGDE-BATLIVALA, SHEELA EVA (MD)
Entity Type:Individual
Prefix:
First Name:SHEELA
Middle Name:EVA
Last Name:HEGDE-BATLIVALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEELA
Other - Middle Name:EVA
Other - Last Name:HEGDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2109
Mailing Address - Fax:617-789-2066
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2109
Practice Address - Fax:617-789-2066
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2033132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0112551Medicaid
MAA31845Medicare ID - Type Unspecified
MA0112551Medicaid