Provider Demographics
NPI:1558011965
Name:SHASHIASHVILI, DUBAI (DO)
Entity Type:Individual
Prefix:DR
First Name:DUBAI
Middle Name:
Last Name:SHASHIASHVILI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KENMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8112
Mailing Address - Country:US
Mailing Address - Phone:203-981-3180
Mailing Address - Fax:
Practice Address - Street 1:425 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2498
Practice Address - Country:US
Practice Address - Phone:203-981-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program