Individual
DR. SANJAY KADANDALE SHETTY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT STREET YAW 6E, RADIOLOGICAL ASSOCIATES, BOSTON, MA 02114-2696
(617) 726-7717
(617) 726-5282
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
210807
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100711
—
MA
01
—
468141
TUFTS HEALTH PLAN
MA
01
—
J28556
BCBS MA
MA
Enumeration date
11/29/2005
Last updated
07/08/2007
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