Provider Demographics
NPI:1134968290
Name:HOSSALI MATH, SHIVA SANDESH (MBBS)
Entity type:Individual
Prefix:
First Name:SHIVA SANDESH
Middle Name:
Last Name:HOSSALI MATH
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 49, SUNY DOWNSTATE MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-2078
Mailing Address - Fax:
Practice Address - Street 1:SUNY DOWNSTATE MEDICAL CENTER
Practice Address - Street 2:450 CLARKSON AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:505-393-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-03-17
Deactivation Date:2025-01-13
Deactivation Code:
Reactivation Date:2025-03-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program