Healthcare Provider Details

I. General information

NPI: 1447461439
Provider Name (Legal Business Name): SHEILA CAROL BUSHKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 TOWPATH LN
WATERFORD NY
12188-4006
US

IV. Provider business mailing address

38 TOWPATH LN
WATERFORD NY
12188-4006
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-0069
  • Fax:
Mailing address:
  • Phone: 518-233-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number153051-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: