Provider Demographics
NPI:1225173370
Name:REITZEN-BASTIDAS, SHARI DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:DIANE
Last Name:REITZEN-BASTIDAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PARK AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5047
Mailing Address - Country:US
Mailing Address - Phone:347-557-8368
Mailing Address - Fax:646-304-1278
Practice Address - Street 1:715 PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5047
Practice Address - Country:US
Practice Address - Phone:347-557-8368
Practice Address - Fax:646-304-1278
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240998207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery