Provider Demographics
NPI:1154457125
Name:SPICER, SHANE STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:STEPHEN
Last Name:SPICER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 MADISON AVE
Mailing Address - Street 2:FL 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2820
Mailing Address - Country:US
Mailing Address - Phone:212-479-8400
Mailing Address - Fax:917-522-9654
Practice Address - Street 1:240 MADISON AVE FL 10B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2820
Practice Address - Country:US
Practice Address - Phone:212-479-8400
Practice Address - Fax:917-522-9654
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-2394212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry