Provider Demographics
NPI:1710260039
Name:SHETTY, NAGALAKSHMI A (MD)
Entity Type:Individual
Prefix:
First Name:NAGALAKSHMI
Middle Name:A
Last Name:SHETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAGALAKSHMI
Other - Middle Name:A
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1322 ROUTE 72 W STE 201
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2486
Mailing Address - Country:US
Mailing Address - Phone:609-597-4178
Mailing Address - Fax:609-597-4384
Practice Address - Street 1:1322 ROUTE 72 W STE 201
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2486
Practice Address - Country:US
Practice Address - Phone:609-597-4178
Practice Address - Fax:609-597-4384
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08977600207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology