Healthcare Provider Details

I. General information

NPI: 1306708268
Provider Name (Legal Business Name): HNADE SHHADE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 HERITAGE RD
TONAWANDA NY
14150-4443
US

IV. Provider business mailing address

138 HERITAGE RD
TONAWANDA NY
14150-4443
US

V. Phone/Fax

Practice location:
  • Phone: 718-909-7371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number033535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: