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Shady Samuel
Pediatric Dentist in Mineola, New York
NPI 1245536382

Shady Samuel is a Pediatric Dentist based in Mineola, NY and is specialized in Pediatric Dentistry. Shady Samuel practices in Mineola, NY. The NPI Number for Shady Samuel is 1245536382 and holds a License No. 055773 (New York).

The current practice location address for Shady Samuel is 18 Jerome Ave, Mineola, NY and can be reached out via phone at 718-268-0452. You can also correspond with Shady Samuel through the mailing address at 18 JEROME AVE, MINEOLA, NY - 11501-3302 (mailing address contact number: ).

Location: 18 Jerome Ave, Mineola, NY, 11501-3302
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1245536382
Provider Name
Shady Samuel
Credential
Provider Entity Type
Individual
Gender
Male
Address
18 Jerome Ave, Mineola, NY, 11501-3302
Phone Number
718-268-0452
Fax Number
Provider Enumeration Date
02/08/2011
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
18 Jerome Ave
City
Mineola
State
New York
Zip
11501-3302
Phone Number
718-268-0452
Fax Number
person
Provider Business Mailing Address Details
Address
18 Jerome Ave
City
Mineola
State
New York
Zip
11501-3302
Phone Number
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
055773 (New York)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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