Provider Demographics
NPI:1134408248
Name:ROY, SHREYAS KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHREYAS
Middle Name:KUMAR
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CEDAR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9485
Mailing Address - Country:US
Mailing Address - Phone:315-436-2421
Mailing Address - Fax:
Practice Address - Street 1:149 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9485
Practice Address - Country:US
Practice Address - Phone:315-436-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAS0552489133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery