Provider Demographics
NPI:1629564786
Name:ARJUN, SHIVA MUKUND (MD)
Entity Type:Individual
Prefix:MR
First Name:SHIVA
Middle Name:MUKUND
Last Name:ARJUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUKUND
Other - Middle Name:SHIVARJUN
Other - Last Name:SANKARAMOORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-572-6501
Mailing Address - Fax:516-572-5609
Practice Address - Street 1:2201 HEMPSTEAD TURNPIKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-572-4835
Practice Address - Fax:516-572-5609
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2024-04-09
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-02-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY323181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program