Individual
SHAWN KAKKATHOTTATHIL MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8814 198TH ST, HOLLIS, NY 11423-2119
(516) 253-4877
Mailing address
8814 198TH ST, HOLLIS, NY 11423-2119
(516) 253-4877
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
318868
NY
207R00000X
Internal Medicine Physician
318868
NY
Other
Enumeration date
04/09/2019
Last updated
02/02/2026
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