Provider Demographics
NPI:1548793201
Name:DARRAH, SHAUN FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:FREDERICK
Last Name:DARRAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 WARBURTON AVE APT 604N
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1131
Mailing Address - Country:US
Mailing Address - Phone:631-398-9376
Mailing Address - Fax:
Practice Address - Street 1:947 S LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-3254
Practice Address - Country:US
Practice Address - Phone:845-621-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0605221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry