Provider Demographics
NPI:1477548543
Name:SHEHATOU, TERIZA B (MD)
Entity Type:Individual
Prefix:DR
First Name:TERIZA
Middle Name:B
Last Name:SHEHATOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7396
Practice Address - Fax:315-470-2806
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236767207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI53405Medicare UPIN
NYRB1132Medicare PIN
NYRB0549Medicare PIN
NYJ400000478Medicare PIN