Provider Demographics
NPI:1447458997
Name:MONGIA, SHELLA KUMAR (MBBS, MD)
Entity type:Individual
Prefix:
First Name:SHELLA
Middle Name:KUMAR
Last Name:MONGIA
Suffix:
Gender:F
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 ELM DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3045
Mailing Address - Country:US
Mailing Address - Phone:917-476-5173
Mailing Address - Fax:
Practice Address - Street 1:381 ELM DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3045
Practice Address - Country:US
Practice Address - Phone:917-476-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020797207ZP0007X
FLME 110585207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology