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NPI Code Detail

MEDICARE: JAMES PATRICK SHASHATY RPA

MEDICARE: JAMES PATRICK SHASHATY RPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant005427NY

General Provider Information

NPI Number : 1073500120
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES PATRICK SHASHATY RPA
Provider Business Mailing Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number : 631-968-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 05/08/2009

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Directions to “ JAMES PATRICK SHASHATY RPA” Practice Location

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