Provider Demographics
NPI:1538137609
Name:SHAMES, CONSTANCE - (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:-
Last Name:SHAMES
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 1:4 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1610
Mailing Address - Country:US
Mailing Address - Phone:516-334-0887
Mailing Address - Fax:718-270-4196
Practice Address - Street 1:4 LINDEN LN
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1610
Practice Address - Country:US
Practice Address - Phone:516-334-0887
Practice Address - Fax:718-270-4196
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363942Medicaid