Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 051583-1 | NY |
NPI | 1083715403 |
---|---|
Provider Name | Ms. Shirley K Molina |
First Address | Roslyn Heights, NY 11577-2125 |
Second Address | Roslyn Heights, NY 11577-2125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |