Fawaz Omar Shihadeh, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

061580-01 Issued in NY

Practice address

111 E 210TH St
Bronx, NY 10467-2401

Phone

(718) 920-4321

NPI assigned

Mar 21, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Banana Smiles Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Elmhurst, NY
  • NPI 1447947924
  NPD Authorized official
• Pediatric Dentistry of Nanuet PLLC

  • Pediatric Dentistry
  • Nanuet, NY
  • NPI 1790219467
  NPD (past)
• S. C. Schwartz, D.D.S., PLLC

  • Pediatric Dentistry
  • Poughkeepsie, NY
  • NPI 1417825985
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1053815282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "243 North Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Poughkeepsie",
            "state": "NY",
            "postal_code": "126011173",
            "country_code": "US",
            "telephone_number": "845-454-3025",
            "fax_number": "845-454-3054",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Old Nyack Tpke Ste 109",
            "address_purpose": "LOCATION",
            "city": "Nanuet",
            "state": "NY",
            "postal_code": "109542449",
            "country_code": "US",
            "telephone_number": "845-507-0100",
            "fax_number": "845-507-0110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIHADEH",
        "first_name": "FAWAZ",
        "middle_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "061580-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amr Abdulhalem Ahmed Shier, MD
• Shifa Health Management Corporation
• Shifa RX LLC
• Miriam Lydia Shiferaw, MD
• Areej Shihabi, MD
• Tahani Shihadeh
• Druti Shikdar-Ahmed, OPTOMETRIST
• Tamar Rebecca Shiller, DMD
• Aisha Shillingford
• Andrina Shillingford, RN

• Pediatric Dentistry in Bronx, NY
• Providers in Bronx, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.