Provider Demographics
NPI:1134256324
Name:SHOEMAKER, VANITA KAVETY (MD)
Entity type:Individual
Prefix:
First Name:VANITA
Middle Name:KAVETY
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VANITA
Other - Middle Name:
Other - Last Name:KAVETY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:377 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8641
Practice Address - Country:US
Practice Address - Phone:518-430-2757
Practice Address - Fax:518-649-4132
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219906207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03301379Medicaid
NY03301379Medicaid
NYJ400035440Medicare PIN