Provider Demographics
NPI:1346272069
Name:DASHEFSKY, LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:DASHEFSKY
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 1:6803 MAYFIELD RD STE 409
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2214
Mailing Address - Country:US
Mailing Address - Phone:440-449-2000
Mailing Address - Fax:440-449-9393
Practice Address - Street 1:6803 MAYFIELD RD STE 409
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2214
Practice Address - Country:US
Practice Address - Phone:440-449-2000
Practice Address - Fax:440-449-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-4912-D2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0657409Medicaid
OH0657409Medicaid
OH4015381Medicare ID - Type Unspecified