Provider Demographics
NPI:1154877850
Name:SHETTY, SANDHYA JAYARAM (PT)
Entity type:Individual
Prefix:
First Name:SANDHYA
Middle Name:JAYARAM
Last Name:SHETTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KENSINGTON RD
Mailing Address - Street 2:201
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2143
Mailing Address - Country:US
Mailing Address - Phone:630-286-8939
Mailing Address - Fax:630-286-8941
Practice Address - Street 1:1420 KENSINGTON RD.
Practice Address - Street 2:201
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-286-8939
Practice Address - Fax:630-286-8941
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009151246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other