Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 05-053882 | NY |
Y | 122300000X | Dentist | 053882 | NY |
N | 122300000X | Dentist | 59115 | CA |
NPI | 1003093352 |
---|---|
Provider Name | Dr. Shawn Sadri |
First Address | New York, NY 10022-5442 |
Second Address | New York, NY 10022-5442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 29/09/2020 |