Provider Demographics
NPI:1538194881
Name:BODANI, SHRIKANT C (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIKANT
Middle Name:C
Last Name:BODANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7073
Mailing Address - Country:US
Mailing Address - Phone:716-483-2161
Mailing Address - Fax:716-483-2160
Practice Address - Street 1:30 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7073
Practice Address - Country:US
Practice Address - Phone:716-483-2161
Practice Address - Fax:716-487-2823
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1478542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776949Medicaid
NY39129BMedicare ID - Type Unspecified
NY00776949Medicaid