Healthcare Provider Details

I. General information

NPI: 1255391124
Provider Name (Legal Business Name): STANLEY SHAPSHAY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HACKETT BLVD
ALBANY NY
12208-3420
US

IV. Provider business mailing address

35 HACKETT BLVD
ALBANY NY
12208-3420
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5575
  • Fax: 518-262-5184
Mailing address:
  • Phone: 518-262-5575
  • Fax: 518-262-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number236607
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: