Provider Demographics
NPI:1598967093
Name:SHETTY, GREESHMA KENYA (MD)
Entity Type:Individual
Prefix:DR
First Name:GREESHMA
Middle Name:KENYA
Last Name:SHETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3112 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7701
Mailing Address - Country:US
Mailing Address - Phone:617-549-4580
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2677
Practice Address - Country:US
Practice Address - Phone:844-847-8216
Practice Address - Fax:415-520-9150
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216632207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA14878OtherHAVARD PILGRIM
MAJ27232OtherBLUE CROSS BLUE SHIELD
MA2044919OtherMASSHEALTH
MASHA37263Medicare ID - Type Unspecified