Datta, Shruti
Datta, Shruti is an individual health care provider with primary practice located at 1415 Portland Ave , Rochester NY 14621-3038. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Geriatric Medicine is her primary health care specialty. Datta, Shruti can be contacted via phone (585) 922-0393.Contact Information
Primary practice address
1415 Portland Ave
Rochester NY 14621-3038
Phone: (585) 922-0393
Fax: (585) 922-0395
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 255593 | New York |
Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 55592 | Minnesota |
Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 106218 | Minnesota |
Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 255593 | New York |
Profile Details
NPI number | 1366643090 |
---|---|
LBN Legal business name | Datta, Shruti |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 30th, 2007 |
Last updated | Dec 15th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1366643090 | NPPES |
New York | MEDICAID | 03299878 | |
New York | MEDICAID | ENROLLED | |
New York | MEDICAID | ENROLLED |
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