Provider Demographics
NPI:1700956919
Name:SHETTY, AMITA A (MD)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:A
Last Name:SHETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 CHARLES LN
Mailing Address - Street 2:APT. 2A
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3088
Mailing Address - Country:US
Mailing Address - Phone:718-920-7460
Mailing Address - Fax:718-655-4371
Practice Address - Street 1:MMC - PSYC. OBSERVATION SERV.
Practice Address - Street 2:111 E. 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2004702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry