Healthcare Provider Details

I. General information

NPI: 1508124207
Provider Name (Legal Business Name): YELIZAVETA SHABASHEV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 09/19/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SUNSET DR
CORAL GABLES FL
33143-5878
US

IV. Provider business mailing address

1535 SUNSET DR
CORAL GABLES FL
33143-5878
US

V. Phone/Fax

Practice location:
  • Phone: 800-895-1570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number23880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: