Healthcare Provider Details

I. General information

NPI: 1225396682
Provider Name (Legal Business Name): SASHA CEKADA DDS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 BROADWAY SUITE 2
AMITYVILLE NY
11701-2761
US

IV. Provider business mailing address

193 BROADWAY SUITE 2
AMITYVILLE NY
11701-2761
US

V. Phone/Fax

Practice location:
  • Phone: 631-598-2940
  • Fax: 631-598-8287
Mailing address:
  • Phone: 631-598-2940
  • Fax: 631-598-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049684
License Number StateNY

VIII. Authorized Official

Name: DR. SASHA DANIEL CEKADA
Title or Position: OWNER
Credential: DDS
Phone: 631-598-2940