Healthcare Provider Details

I. General information

NPI: 1366142358
Provider Name (Legal Business Name): STEWART SHABANAJ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BATAVIA CITY CTR
BATAVIA NY
14020-2107
US

IV. Provider business mailing address

54 TAMARK CT
BUFFALO NY
14227-1242
US

V. Phone/Fax

Practice location:
  • Phone: 585-479-3103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number063995
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045120
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: