Basic Information
| Provider Information | |||||||||
| NPI: | 1982667689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYADGI | ||||||||
| FirstName: | SHALINI | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND STREET | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458563284 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183371703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702962818 | ||||||||
| FaxNumber: | 5704091702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 237319 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD427937 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02705897 | 05 | NY | MEDICAID | 1018510470007 | 05 | PA | MEDICAID |