Individual
SHELLY STEPHENS GROENENDYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2190
(516) 382-7399
Mailing address
25 ROCKY HILL RD, MOUNT SINAI, NY 11766-1213
(801) 205-1033
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
10516430-1205
UT
207L00000X
Anesthesiology Physician
Primary
329018
NY
207L00000X
Anesthesiology Physician
63603
TN
Other
Enumeration date
05/10/2016
Last updated
11/03/2024
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