Basic Information
| Provider Information | |||||||||
| NPI: | 1902811615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMLEY SOOD | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14890 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122124890 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2125 RIVER RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183828350 | ||||||||
| FaxNumber: | 5183820345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 227312 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 10099368 | 01 | NY | CDPHP | OTHER | 3X6311 | 01 | NY | EMPIRE BC | OTHER | 061214000028 | 01 | NY | FIDELIS | OTHER | 200253 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 7586702 | 01 | NY | AETNA | OTHER | 000409908001 | 01 | NY | BSNENY | OTHER | 02673912 | 05 | NY | MEDICAID | 100556 | 01 | NY | GHI/HMO | OTHER | 384959 | 01 | NY | MVP | OTHER |