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NPI Code Detail

MEDICARE: KELSEY FISHER-SHAIN DO

MEDICARE: KELSEY FISHER-SHAIN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1922801521
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY FISHER-SHAIN DO
Provider Business Mailing Address
First Line : 33 SANDY HILL RD
Second Line :
City : COMMACK
State : NY
Zip : 11725-2530
Country : US
Telephone Number : 631-834-5915
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number : 631-894-5364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2025
Last Update Date : 06/10/2026

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Directions to “ KELSEY FISHER-SHAIN DO” Practice Location

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