Healthcare Provider Details

I. General information

NPI: 1962088997
Provider Name (Legal Business Name): JONATHAN SHAYA SESSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CENTER ST
CUBA NY
14727-1002
US

IV. Provider business mailing address

5 BEACON PARK APT L
AMHERST NY
14228-2573
US

V. Phone/Fax

Practice location:
  • Phone: 585-968-8400
  • Fax:
Mailing address:
  • Phone: 716-984-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number062571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: