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General NPI Number Information
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NPI Number | 1548793201
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Entity Type | Individual
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Provider Name | SHAUN FREDERICK DARRAH DDS
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Gender | Male
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Dates
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Enumeration Date | 04/09/2017
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 947 S LAKE BLVD
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City | MAHOPAC
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State | NY
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Zip | 10541-3254
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Country | US
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Telephone | 845-621-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 WARBURTON AVE APT 604N
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City | YONKERS
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State | NY
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Zip | 10701-1131
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Country | US
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Telephone | 631-398-9376
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 060522
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License Number State | NY
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