Basic Information
Provider Information
NPI: 1184076507
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATNASINGAM
FirstName: SHAMANTHY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUTHRIE SQ
Address2:  
City: SAYRE
State: PA
PostalCode: 188401625
CountryCode: US
TelephoneNumber: 5708885858
FaxNumber:  
Practice Location
Address1: 82 COPELAND AVE
Address2:  
City: HOMER
State: NY
PostalCode: 130771528
CountryCode: US
TelephoneNumber: 0767531025
FaxNumber: 6077531285
Other Information
ProviderEnumerationDate: 07/09/2016
LastUpdateDate: 03/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X299495NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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