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General NPI Number Information
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NPI Number | 1205213337
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Entity Type | Individual
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Provider Name | DOMINICK ANTHONY SHAO-BERKERY
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Gender | Male
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 66 SHERIDAN AVE
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City | WALDWICK
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State | NJ
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Zip | 07463-2210
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Country | US
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Telephone | 415-999-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 622 WEST 168TH STREET PH 505, 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 415-999-6543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 598181
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95000377
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License Number State | CA
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