Individual
DR. SHANTIKUMAR D. BEDMUTHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
176 HALSTON PKWY, E AMHERST, NY 14051-1890
(716) 636-5877
(716) 439-6264
Mailing address
176 HALSTON PKWY, E AMHERST, NY 14051-1890
(716) 636-5877
(716) 439-6264
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
147852-1
NY
2085R0202X
Diagnostic Radiology Physician
Primary
147852-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011395901
UNIVERA
—
01
—
00026885902
UNIVERA
—
01
—
000524500002
BLUE SHIELD OF WESTERN NY
—
01
—
000525091012
BLUE SHIELD OF WESTERN NY
—
01
—
000525091013
BLUE SHIELD OF WESTERN NY
—
01
—
00525091015
BLUE SHIELD OF WESTERN NY
—
05
—
01561462
—
NY
01
—
040426001647
FIDELIS
—
01
—
10136630
FIDELIS
—
01
—
145801FF
PREFERRED CARE
—
01
—
1609861
INDEPENDENT HEALTH
—
01
—
300081886
RAILROAD MEDICARE
—
01
—
300097080
RAILROAD MEDICARE
—
01
—
P00003643
RAILROAD MEDICARE
—
01
—
P00080950
MEDICARE RAILROAD
NY
01
—
R1478521
WORKERS COMPENSATION
NY
Enumeration date
04/19/2006
Last updated
07/29/2008
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