Healthcare Provider Details

I. General information

NPI: 1780046086
Provider Name (Legal Business Name): SHARONA SHIMUNOVA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NORTHERN BLVD STE 102
MANHASSET NY
11030
US

IV. Provider business mailing address

13677 72ND AVE
FLUSHING NY
11367-2327
US

V. Phone/Fax

Practice location:
  • Phone: 516-268-8807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number059933
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: