Provider Demographics
NPI:1235452665
Name:SHEBAIRO, KEITH ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:SHEBAIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-437-5500
Mailing Address - Fax:
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-437-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2256682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry