Provider Demographics
NPI:1255374641
Name:SHETTY, RAJESH A (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:A
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DACY LN STE 110
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4194
Mailing Address - Country:US
Mailing Address - Phone:512-268-8126
Mailing Address - Fax:512-268-8121
Practice Address - Street 1:4100 EVERETT, SUITE 210
Practice Address - Street 2:PLUM CREEK CENTER
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6112
Practice Address - Country:US
Practice Address - Phone:512-268-8126
Practice Address - Fax:512-986-7608
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9003207RS0012X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH60574Medicare UPIN
NY055AKIMedicare ID - Type Unspecified