Individual
SHADY SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18 JEROME AVE, MINEOLA, NY 11501-3302
(718) 268-0452
Mailing address
18 JEROME AVE, MINEOLA, NY 11501-3302
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
055773
NY
Other
Enumeration date
02/08/2011
Last updated
08/15/2017
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