Provider Demographics
NPI:1477916724
Name:WHITEMAN, SHAYNA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:NICOLE
Last Name:WHITEMAN
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 1:285 AYCRIGG AVE APT 5K
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3722
Mailing Address - Country:US
Mailing Address - Phone:718-764-7290
Mailing Address - Fax:
Practice Address - Street 1:141 US HIGHWAY 46 LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4018
Practice Address - Country:US
Practice Address - Phone:973-625-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026635021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics