Provider Demographics
NPI:1639160559
Name:VASA, SHAILA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAILA
Middle Name:
Last Name:VASA
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 1:257 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1736
Mailing Address - Country:US
Mailing Address - Phone:516-868-1892
Mailing Address - Fax:516-868-1892
Practice Address - Street 1:257 NASSAU RD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1736
Practice Address - Country:US
Practice Address - Phone:516-868-1892
Practice Address - Fax:516-868-1892
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005698OtherDORAL
NY00350207Medicaid
NY26179OtherGHI