Healthcare Provider Details

I. General information

NPI: 1689658304
Provider Name (Legal Business Name): DANIEL SHASHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL SLOAN KETTERING CANCER CENTER 1275 YORK AVENUE
NEW YORK NY
10065
US

IV. Provider business mailing address

985 BUCKINGHAM CIR NW
ATLANTA GA
30327-2701
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone: 917-673-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number56678
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number075671
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number195589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: