Provider Demographics
NPI:1609985787
Name:MADHERE, SHIRLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:M
Last Name:MADHERE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14361 227TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3539
Mailing Address - Country:US
Mailing Address - Phone:212-941-1571
Mailing Address - Fax:212-994-8083
Practice Address - Street 1:594 BROADWAY RM 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3234
Practice Address - Country:US
Practice Address - Phone:212-941-1571
Practice Address - Fax:212-941-8083
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY218654208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74088Medicare UPIN