Provider Demographics
NPI:1528269040
Name:PRADHAN, TANA SHAH (DO)
Entity type:Individual
Prefix:DR
First Name:TANA
Middle Name:SHAH
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TANA
Other - Middle Name:ROHIT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 2575S
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-2181
Practice Address - Fax:914-493-2322
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253286207VX0201X
NJ25MB08307600207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03460991Medicaid
NYA400073154Medicare PIN