Provider Demographics
NPI:1376682989
Name:MASHINIC, ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:
Last Name:MASHINIC
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 1:80 WILLIAM DONNELLY INDUS PKWY
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1500
Mailing Address - Country:US
Mailing Address - Phone:607-565-9594
Mailing Address - Fax:607-565-7194
Practice Address - Street 1:80 WILLIAM DONNELLY INDUS PKWY
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1500
Practice Address - Country:US
Practice Address - Phone:607-565-9594
Practice Address - Fax:607-565-7194
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2129892084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
39062AOtherEMPLOYER MEDICARE PROVIDE
NY00618162OtherEMPLOYER MEDICAID PROVIDE