Provider Demographics
NPI:1699741280
Name:ADHVARYU, SHRADDHA KARTIKEY (BDS MDS DDS)
Entity type:Individual
Prefix:DR
First Name:SHRADDHA
Middle Name:KARTIKEY
Last Name:ADHVARYU
Suffix:
Gender:F
Credentials:BDS MDS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-746-3654
Mailing Address - Fax:516-746-3715
Practice Address - Street 1:1015 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-746-3654
Practice Address - Fax:516-746-3715
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04259411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01583908Medicaid