Provider Demographics
NPI:1548861800
Name:JALLIM, SHEVANIE LATCHMI (OD)
Entity type:Individual
Prefix:
First Name:SHEVANIE
Middle Name:LATCHMI
Last Name:JALLIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHEVANIE
Other - Middle Name:LATCHMI
Other - Last Name:SHIWDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:87 REILLY RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-6120
Mailing Address - Country:US
Mailing Address - Phone:845-392-2592
Mailing Address - Fax:
Practice Address - Street 1:26 W MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2243
Practice Address - Country:US
Practice Address - Phone:845-896-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009279-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist