Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 168638 | NY |
NPI | 1073514998 |
---|---|
Provider Name | Dr. Branda Shrivastava |
First Address | West Islip, NY 11795-4927 |
Second Address | West Islip, NY 11795-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19057 | (02) | NY |