Provider Demographics
NPI:1821043118
Name:MENOLASCINO, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:MENOLASCINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WASHINGTON SQ W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9181
Mailing Address - Country:US
Mailing Address - Phone:212-647-9187
Mailing Address - Fax:212-243-1451
Practice Address - Street 1:7 PATCHIN PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8341
Practice Address - Country:US
Practice Address - Phone:212-647-9187
Practice Address - Fax:212-243-1451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1849092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434519Medicaid
NY01434519Medicaid
NY54H661Medicare ID - Type UnspecifiedPSYCHIATRY