Healthcare Provider Details

I. General information

NPI: 1730147554
Provider Name (Legal Business Name): TODD S SHATYNSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 WASHINGTON AVE STE 200
ALBANY NY
12206-1048
US

IV. Provider business mailing address

1367 WASHINGTON AVE STE 200
ALBANY NY
12206-1048
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2666
  • Fax: 518-489-5933
Mailing address:
  • Phone: 518-489-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD424294
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD424294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: