Provider Demographics
NPI:1477729309
Name:SANFORD SHAEV, D.D.S.
Entity Type:Organization
Organization Name:SANFORD SHAEV, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-699-6191
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-699-6191
Mailing Address - Fax:
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-699-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01537351Medicaid