Provider Demographics
NPI:1689458622
Name:SAJIKUMAR, SHIVANI (OD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SAJIKUMAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8238
Mailing Address - Country:US
Mailing Address - Phone:631-902-3481
Mailing Address - Fax:
Practice Address - Street 1:700 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8238
Practice Address - Country:US
Practice Address - Phone:631-792-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRT009898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist