Provider Demographics
NPI:1639136963
Name:RAO, ROSHNI (MD)
Entity Type:Individual
Prefix:
First Name:ROSHNI
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSHNI
Other - Middle Name:
Other - Last Name:SHUKLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-9676
Mailing Address - Fax:212-305-1522
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-9676
Practice Address - Fax:212-305-1522
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2909772086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175162001Medicaid
TXRA08D7807Medicare ID - Type Unspecified