Provider Demographics
NPI:1740979319
Name:SHAUN DARRAH PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:SHAUN DARRAH PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-398-9376
Mailing Address - Street 1:1133 WARBURTON AVE
Mailing Address - Street 2:APT. 604 N.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:631-398-9376
Mailing Address - Fax:
Practice Address - Street 1:1133 WARBURTON AVE
Practice Address - Street 2:APT. 604 N.
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:631-398-9376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty