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Individual
DR. SHYAM CHANDRU SHIVDASANI
Active
Individual
DR. SHYAM CHANDRU SHIVDASANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
196192
NY
207R00000X
Internal Medicine Physician
Primary
196192
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002918
CONNECTICARE ID#
NY
05
—
01851505
—
NY
01
—
1033222468
COMMERICAL CARRIERS
NY
01
—
163AJ3
EMPIRE BC/BS ID #
NY
01
—
196192
HIP ID #
NY
01
—
2592106
GHI ID #
NY
01
—
3359089
AETNA HMO ID#
NY
01
—
3C2846
PHS HEALTHNET ID#
NY
01
—
5387184
AETNA PPO ID#
NY
01
—
P00311425
MEDICARE RAILROAD
NY
01
—
WP738
OXFORD ID #
NY
Enumeration date
08/17/2006
Last updated
09/29/2023
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