Provider Demographics
NPI:1831594803
Name:SHELLY MENOLASCINO MD, LLC
Entity type:Organization
Organization Name:SHELLY MENOLASCINO MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENOLASCINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-647-9187
Mailing Address - Street 1:37 WASHINGTON SQUARE WEST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9119
Mailing Address - Country:US
Mailing Address - Phone:212-647-9187
Mailing Address - Fax:212-243-1451
Practice Address - Street 1:37 WASHINGTON SQUARE WEST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9119
Practice Address - Country:US
Practice Address - Phone:212-647-9187
Practice Address - Fax:212-243-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1849092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434519Medicaid