Provider Demographics
NPI:1770932303
Name:TATAR, SHANE (PA)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:TATAR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:221 BROADWAY
Mailing Address - Street 2:207
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2780
Mailing Address - Country:US
Mailing Address - Phone:631-598-0009
Mailing Address - Fax:631-598-0099
Practice Address - Street 1:389 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2723
Practice Address - Country:US
Practice Address - Phone:516-867-5132
Practice Address - Fax:516-867-5519
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2023-05-23
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Provider Licenses
StateLicense IDTaxonomies
NY019324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical