Provider Demographics
NPI:1932150877
Name:SHETH, SHITAL (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:
Last Name:SHETH
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 1:609 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4540
Mailing Address - Country:US
Mailing Address - Phone:516-489-8888
Mailing Address - Fax:516-489-6262
Practice Address - Street 1:609 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4540
Practice Address - Country:US
Practice Address - Phone:516-489-8888
Practice Address - Fax:516-489-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2336072080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02734458Medicaid