Active NPI
Suhail Shadoud, D.D.S.
- Dentist
- New York, NY
National Provider Identifier
1164616439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 049886
- Practice address
- 610 W 185TH St
New York, NY 10033-3101 - Phone
- (212) 927-4343
- Fax
- (212) 740-2027
- NPI assigned
- Aug 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 049886 | NY | Primary |
Addresses
Primary practice location
610 W 185TH St
New York, NY 10033-3101
Mailing address
610 W 185TH St
New York, NY 10033-3101
Phone (212) 927-4343
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02249416 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049886 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257206400000",
"number": "1164616439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 W 185TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100333101",
"telephone_number": "212-927-4343",
"fax_number": "212-740-2027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 W 185TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100333101",
"telephone_number": "212-927-4343",
"fax_number": "212-740-2027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADOUD",
"first_name": "SUHAIL",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-30",
"last_updated": "2009-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "049886",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02249416",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.