Provider Demographics
NPI:1356707897
Name:SHETH, SUPRINA S (RPH)
Entity type:Individual
Prefix:DR
First Name:SUPRINA
Middle Name:S
Last Name:SHETH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3221
Mailing Address - Country:US
Mailing Address - Phone:631-270-4052
Mailing Address - Fax:
Practice Address - Street 1:5 TWILIGHT CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3221
Practice Address - Country:US
Practice Address - Phone:631-270-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist