Individual
GAUTAM ANAND SHRIVASTAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 689-8333
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
000
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2022
Last updated
07/04/2025
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