Provider Demographics
NPI:1750670931
Name:SHETTY, SIRIKISHAN RAMKISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIRIKISHAN
Middle Name:RAMKISHAN
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIRI
Other - Middle Name:
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1305 YORK AVE
Mailing Address - Street 2:FLOOR 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5663
Mailing Address - Country:US
Mailing Address - Phone:646-962-2020
Mailing Address - Fax:646-962-0609
Practice Address - Street 1:1305 YORK AVE
Practice Address - Street 2:FLOOR 11
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5663
Practice Address - Country:US
Practice Address - Phone:646-962-2020
Practice Address - Fax:646-962-0609
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279126-1207W00000X, 207WX0120X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program