Provider Demographics
NPI:1659680692
Name:GANGULY, SHRISHTI (MD)
Entity Type:Individual
Prefix:
First Name:SHRISHTI
Middle Name:
Last Name:GANGULY
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 1:903 PROVIDENCE PL APT 127
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-7003
Mailing Address - Country:US
Mailing Address - Phone:917-704-2540
Mailing Address - Fax:
Practice Address - Street 1:10 CRANSTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2623
Practice Address - Country:US
Practice Address - Phone:917-704-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01072969A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program