Provider Demographics
NPI:1053442384
Name:SHUSTIK, DAVID ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:SHUSTIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 IRVING ST
Mailing Address - Street 2:APARTMENT #304
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2225
Mailing Address - Country:US
Mailing Address - Phone:415-681-8223
Mailing Address - Fax:
Practice Address - Street 1:925 IRVING ST
Practice Address - Street 2:APARTMENT #304
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2225
Practice Address - Country:US
Practice Address - Phone:415-681-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANOT LICENSED208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery