Provider Demographics
NPI:1700156213
Name:KANDASWAMY, SHAKUNTHALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKUNTHALA
Middle Name:
Last Name:KANDASWAMY
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 1:6415 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2331
Mailing Address - Country:US
Mailing Address - Phone:718-606-1200
Mailing Address - Fax:
Practice Address - Street 1:6415 35TH AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2331
Practice Address - Country:US
Practice Address - Phone:718-606-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1366822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry