Provider Demographics
NPI:1821023854
Name:BOGHANI, SHOBHA (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:
Last Name:BOGHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 659
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:585-276-0236
Practice Address - Street 1:1455 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2006
Practice Address - Country:US
Practice Address - Phone:585-922-4315
Practice Address - Fax:585-922-5741
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218035207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097143Medicaid
NYCC2267Medicare ID - Type Unspecified