Provider Demographics
NPI:1659539880
Name:MARYLES, SHAREEN G (MD)
Entity Type:Individual
Prefix:
First Name:SHAREEN
Middle Name:G
Last Name:MARYLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:MARYLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:316 E 30TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8366
Mailing Address - Country:US
Mailing Address - Phone:212-614-0039
Mailing Address - Fax:212-253-9631
Practice Address - Street 1:235 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2709
Practice Address - Country:US
Practice Address - Phone:212-599-2297
Practice Address - Fax:212-599-4554
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236641207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOTH000Medicare UPIN