Provider Demographics
NPI:1003093352
Name:SADRI, SHAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:SADRI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MADISON AVE RM 1710
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5442
Mailing Address - Country:US
Mailing Address - Phone:212-256-0687
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE RM 1710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5442
Practice Address - Country:US
Practice Address - Phone:212-256-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05-053882122300000X
CA59115122300000X
NY053882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist