Basic Information
| Provider Information | |||||||||
| NPI: | 1144761438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAMBHATI | ||||||||
| FirstName: | SHRAVYA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 ALBANY ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021183549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144639 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 WATER ST STE 1A | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024764814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144639 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.071069 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207RG0300X | 281492 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.