Healthcare Provider Details

I. General information

NPI: 1306136239
Provider Name (Legal Business Name): SHARI DIANA SEINUK-ROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5302
US

IV. Provider business mailing address

900 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5302
US

V. Phone/Fax

Practice location:
  • Phone: 516-916-4099
  • Fax:
Mailing address:
  • Phone: 516-916-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: