Provider Demographics
NPI:1740365832
Name:SHEVDE, NIRMALA K (MD)
Entity type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:K
Last Name:SHEVDE
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 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-354-5700
Mailing Address - Fax:516-354-6095
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-354-5700
Practice Address - Fax:516-354-6095
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2971212971OtherMEDICARE ID
29712Medicare ID - Type Unspecified
2971212971OtherMEDICARE ID