Provider Demographics
NPI:1689822553
Name:DHAGE, SHUBHADA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBHADA
Middle Name:M
Last Name:DHAGE
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 1:120 MINEOLA BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4077
Mailing Address - Country:US
Mailing Address - Phone:516-663-3300
Mailing Address - Fax:
Practice Address - Street 1:120 MINEOLA BLVD STE 320
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4077
Practice Address - Country:US
Practice Address - Phone:516-663-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244635282N00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282N00000XHospitalsGeneral Acute Care Hospital