Provider Demographics
NPI:1720370869
Name:PACKIANATHAN, VATHANI SHARON (MD)
Entity Type:Individual
Prefix:
First Name:VATHANI
Middle Name:SHARON
Last Name:PACKIANATHAN
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 1:333 INTERNATIONAL DR
Mailing Address - Street 2:B1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5726
Mailing Address - Country:US
Mailing Address - Phone:716-633-5277
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 57TH STREET
Practice Address - Street 2:15TH AND 16TH STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284414207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine