Healthcare Provider Details

I. General information

NPI: 1386720100
Provider Name (Legal Business Name): REGINA SHANTA SEXTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

PO BOX 634863
CINCINNATI OH
45263-0042
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4349
  • Fax: 937-534-0166
Mailing address:
  • Phone: 800-290-5282
  • Fax: 937-534-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number222743-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: