Healthcare Provider Details

I. General information

NPI: 1619955564
Provider Name (Legal Business Name): SASHA DANIEL CEKADA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 BROADWAY
AMITYVILLE NY
11701-2761
US

IV. Provider business mailing address

25201 58TH AVE #2
LITTLE NECK NY
11362-2113
US

V. Phone/Fax

Practice location:
  • Phone: 631-598-2940
  • Fax: 631-598-8287
Mailing address:
  • Phone: 718-767-3504
  • Fax: 718-969-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: