Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 252781 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 252781 | NY |
N | 207VX0201X | Gynecologic Oncologist | ME 89380 | FL |
NPI | 1548275902 |
---|---|
Provider Name | Dr. Sean Shaheen Tedjarati |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03119082 | (05) | NY |
G50848 | (02) | FL |