Healthcare Provider Details

I. General information

NPI: 1508552092
Provider Name (Legal Business Name): GEORGE SHEHATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E STATE ST
HERKIMER NY
13350-2389
US

IV. Provider business mailing address

111 HOSPITAL DR
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-574-2300
  • Fax: 315-574-2310
Mailing address:
  • Phone: 315-624-6099
  • Fax: 315-624-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: