Basic Information
| Provider Information | |||||||||
| NPI: | 1477552065 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FIDVI | ||||||||
| FirstName: | SHABNAM | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 WESTCHESTER AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148722502 | ||||||||
| FaxNumber: | 9147822470 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105911020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143663450 | ||||||||
| FaxNumber: | 9143661514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 002181 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.