Provider Demographics
NPI:1558563536
Name:PASTERNAK, SHELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:PASTERNAK
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 1:25 POWDER HORN DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2426
Mailing Address - Country:US
Mailing Address - Phone:845-362-1252
Mailing Address - Fax:
Practice Address - Street 1:17 SQUADRON BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5214
Practice Address - Country:US
Practice Address - Phone:845-825-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2386972084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry