Provider Demographics
NPI:1982667689
Name:BYADGI, SHALINI C (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:C
Last Name:BYADGI
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 1:20 GRAND STREET
Mailing Address - Street 2:3RD FL
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-856-3284
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:601 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1703
Practice Address - Country:US
Practice Address - Phone:570-296-2818
Practice Address - Fax:570-409-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237319207R00000X
PAMD427937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02705897Medicaid
PA1018510470007Medicaid
NY02705897Medicaid
NY1807V2Medicare ID - Type UnspecifiedPROVIDER NUMBER