Provider Demographics
NPI:1427636893
Name:PUNJWANI, SHOHEERA (DO)
Entity type:Individual
Prefix:
First Name:SHOHEERA
Middle Name:
Last Name:PUNJWANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHOHEERA
Other - Middle Name:
Other - Last Name:KHALIQDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-737-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2024-07-25
Deactivation Date:2024-06-24
Deactivation Code:
Reactivation Date:2024-07-24
Provider Licenses
StateLicense IDTaxonomies
RICLP05813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology