Provider Demographics
NPI:1447625439
Name:SHENOY, KANCHAN
Entity type:Individual
Prefix:
First Name:KANCHAN
Middle Name:
Last Name:SHENOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIDEN LN STE NO404
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4810
Mailing Address - Country:US
Mailing Address - Phone:646-290-9560
Mailing Address - Fax:212-532-4362
Practice Address - Street 1:75 MAIDEN LN STE NO404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:646-290-9560
Practice Address - Fax:212-532-4362
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist