Provider Demographics
NPI:1255469466
Name:SHIMUNY, MARINA U (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:U
Last Name:SHIMUNY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1610
Mailing Address - Country:US
Mailing Address - Phone:718-433-9126
Mailing Address - Fax:718-433-9106
Practice Address - Street 1:5420 31ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1610
Practice Address - Country:US
Practice Address - Phone:718-433-9126
Practice Address - Fax:718-433-9106
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02620597Medicaid