Provider Demographics
NPI:1689658304
Name:SHASHA, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHASHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BUCKINGHAM CIR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2701
Mailing Address - Country:US
Mailing Address - Phone:917-673-8695
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL SLOAN KETTERING CANCER CENTER
Practice Address - Street 2:1275 YORK AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT566782085R0001X
GA0756712085R0001X
NY1955892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777242Medicaid
NY01777242Medicaid
NYG25981Medicare UPIN
NY9606912661Medicare PIN
NY9606912661Medicare PIN
GA003175564BMedicaid