Healthcare Provider Details

I. General information

NPI: 1699526111
Provider Name (Legal Business Name): SHAY MARKOVITCH DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 STATE ROUTE 63
WAYLAND NY
14572-9626
US

IV. Provider business mailing address

2288 STATE ROUTE 63
WAYLAND NY
14572-9626
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-5200
  • Fax:
Mailing address:
  • Phone: 585-728-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ELIZABETH WORTHMAN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 845-901-0702