Provider Demographics
NPI:1811488398
Name:SHAMMAY, NATHANEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHANEL
Middle Name:A
Last Name:SHAMMAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ASHBURY RD APT 308
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1112
Mailing Address - Country:US
Mailing Address - Phone:954-253-0212
Mailing Address - Fax:
Practice Address - Street 1:100 ASHBURY RD APT 308
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1112
Practice Address - Country:US
Practice Address - Phone:954-253-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060515122300000X
SC101081223G0001X
390200000X
SCDGD.103081223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program