Provider Demographics
NPI:1487613683
Name:SHETTY, ASHWIN K (DO)
Entity type:Individual
Prefix:
First Name:ASHWIN
Middle Name:K
Last Name:SHETTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 SNOWMOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2848
Mailing Address - Country:US
Mailing Address - Phone:509-895-7321
Mailing Address - Fax:509-895-7321
Practice Address - Street 1:4811 SNOWMOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2848
Practice Address - Country:US
Practice Address - Phone:509-895-7321
Practice Address - Fax:509-895-7321
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221207-1207P00000X
WAA02285207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176630Medicaid
NY1768Q1OtherBLUECROSS BLUESHIELD
NY1768Q1OtherBLUECROSS BLUESHIELD
NY02176630Medicaid