Provider Demographics
NPI:1982389342
Name:SHOBHA, FNU (ARDMS)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:SHOBHA
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5758 246TH CRES APT 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1908
Mailing Address - Country:US
Mailing Address - Phone:201-354-7437
Mailing Address - Fax:
Practice Address - Street 1:380 N BROADWAY STE 305
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2109
Practice Address - Country:US
Practice Address - Phone:866-363-1222
Practice Address - Fax:718-586-3766
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
2471S1302X
NY2503992471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography