Provider Demographics
NPI:1255987236
Name:SAWANT, SHRADDHALI RAVINDRA (MS PT)
Entity type:Individual
Prefix:
First Name:SHRADDHALI
Middle Name:RAVINDRA
Last Name:SAWANT
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 COURT ST STE 1210
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4867
Mailing Address - Country:US
Mailing Address - Phone:312-647-4724
Mailing Address - Fax:
Practice Address - Street 1:460 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4058
Practice Address - Country:US
Practice Address - Phone:212-539-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist