Provider Demographics
NPI:1285686733
Name:SHENOY, SADASHIV SARVOTHAM (MD)
Entity type:Individual
Prefix:DR
First Name:SADASHIV
Middle Name:SARVOTHAM
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4488 E OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6310
Mailing Address - Country:US
Mailing Address - Phone:716-631-8736
Mailing Address - Fax:
Practice Address - Street 1:2949 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1356
Practice Address - Country:US
Practice Address - Phone:716-876-4033
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121816-12085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00664695Medicaid
NYBA0056Medicare ID - Type UnspecifiedGROUP
NY00664695Medicaid
NYC49692Medicare UPIN