Basic Information
| Provider Information | |||||||||
| NPI: | 1215058359 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHETTY | ||||||||
| FirstName: | ANIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 BRADBURY DR SE | ||||||||
| Address2: | SUITE 2222 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2211 LOMAS BLVD NE | ||||||||
| Address2: | UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871062719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725504 | ||||||||
| FaxNumber: | 5052721669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 4301075872 | MI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | A 96895 | CA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | MD2009-0440 | NM | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208600000X | 4301075872 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A 96895 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD2009-0440 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0122X | A 96895 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086S0122X | MD2009-0440 | NM | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.