Provider Demographics
NPI:1710397906
Name:SHENOY, VIKRAM KUDGI
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:KUDGI
Last Name:SHENOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 3201
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2094
Mailing Address - Country:US
Mailing Address - Phone:302-623-4323
Mailing Address - Fax:302-623-4315
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2094
Practice Address - Country:US
Practice Address - Phone:302-623-4323
Practice Address - Fax:302-623-4315
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0013195207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine