Doctor Name: | MICHAEL RICHARD SHELESTAK |
NPI Number: | 1396158986 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DMD |
License Number: | |
Business Practice Address: | 3115 Main St West Middlesex, PA - 161593411 |
Business Phone Number: | 7245281515 |
Business Fax Number: | 7245280217 |
Mailing Address: | Po Box 636896, CINCINNATI |
State: | OH |
Postal Code: | 452636896 |
Phone Number: | 3308847158 |
Fax Number: | 3308847175 |
NPI Enumeration Date: | 06/11/2014 |
NPI Last Update Date: | 10/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |