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DR. SHRUTI DATTA M.D. NPI 1366643090


NPI Information

NPI: 1366643090
Provider Name: DR. SHRUTI DATTA, M.D.
Classification: Internal Medicine - 207RG0300X
Entity Type: Individual

Specialization: Geriatric Medicine

PECOS Registration: Yes

Address:
1415 PORTLAND AVE
ROCHESTER, NY
ZIP 14621
Phone: (585) 922-0393
Get Directions

DR. Shruti Datta, M.D. is a geriatric medicine internal medicine in Rochester, NY. The provider is an internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. DR. Shruti Datta, M.D. NPI is 1366643090. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1415 PORTLAND AVE
ROCHESTER, NY
ZIP 14621-038
Phone: (585) 922-0393
Fax: (585) 922-0395

The NPI 1366643090 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/30/2007 and was last updated on 12/15/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0300XInternal MedicineGeriatric Medicine55592MINNESOTANo
22084P0800XPsychiatry & NeurologyPsychiatry106218MINNESOTANo
3207RG0300XInternal MedicineGeriatric Medicine255593NEW YORKYes
4207R00000XInternal Medicine255593NEW YORKNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ENROLLEDMEDICAIDIOWA
203299878MEDICAIDNEW YORK
3ENROLLEDMEDICAIDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.