Provider Demographics
NPI:1619243847
Name:SHAW, MELISSA HOLLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:HOLLY
Last Name:SHAW
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 1:50 WINDINGWOOD RD S
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1124
Mailing Address - Country:US
Mailing Address - Phone:917-922-1231
Mailing Address - Fax:
Practice Address - Street 1:50 WINDINGWOOD RD S
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1124
Practice Address - Country:US
Practice Address - Phone:917-922-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist