Individual
MAHADEVAN SHETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
385 MAIN ST S,, C/O NVRA UNION SQUARE BLDG#1, SOUTHBURY, CT 06488-4240
(203) 264-7999
(203) 264-7477
Mailing address
385 MAIN ST S,, C/O NVRA UNION SQUARE BLDG #1, SOUTHBURY, CT 06488-4240
(203) 264-7999
(203) 264-7477
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
020421
CT
2085R0202X
Diagnostic Radiology Physician
Primary
020421
CT
2085U0001X
Diagnostic Ultrasound Physician
020421
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001204213
—
CT
Enumeration date
07/10/2006
Last updated
05/18/2010
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