Healthcare Provider Details

I. General information

NPI: 1841811148
Provider Name (Legal Business Name): STUART DANIEL SHANLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 03/29/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 15TH ST APT 5L
NEW YORK NY
10003-3536
US

IV. Provider business mailing address

145 E 15TH ST APT 5L
NEW YORK NY
10003-3536
US

V. Phone/Fax

Practice location:
  • Phone: 845-789-5665
  • Fax:
Mailing address:
  • Phone: 845-789-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME96641
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2005-0764
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME96641
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number180782
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD2005-0764
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME96641
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD2005-0764
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number180782
License Number StateNY
# 9
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number180782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: