Individual
SHETRA SIVAMURTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8934 134TH ST, JAMAICA, NY 11418-2819
(718) 526-3899
(718) 526-3233
Mailing address
8934 134TH ST, JAMAICA, NY 11418-2819
(718) 526-3899
(718) 526-3233
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
111600
NY
207RH0003X
Hematology & Oncology Physician
Primary
111600
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111600
NYS LICENSE NUMBER
NY
Enumeration date
06/10/2005
Last updated
10/07/2011
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