Provider Demographics
NPI:1902811615
Name:COMLEY SOOD, SHANNON (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:COMLEY SOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-382-8350
Practice Address - Fax:518-382-0345
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227312207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10099368OtherCDPHP
NY3X6311OtherEMPIRE BC
NY061214000028OtherFIDELIS
NY200253OtherSENIOR WHOLE HEALTH
NY7586702OtherAETNA
NY000409908001OtherBSNENY
NY02673912Medicaid
NY100556OtherGHI/HMO
NY384959OtherMVP
NY061214000028OtherFIDELIS
NY100556OtherGHI/HMO