Provider Demographics
NPI:1558896969
Name:SOCKANATHAN, SHIVANI (MD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SOCKANATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S POINTE LNDG STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3483
Mailing Address - Country:US
Mailing Address - Phone:201-919-1233
Mailing Address - Fax:
Practice Address - Street 1:10 S POINTE LNDG STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3483
Practice Address - Country:US
Practice Address - Phone:201-919-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296672207Q00000X
MO2020022479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine