Provider Demographics
NPI:1104694231
Name:MOSBY, SHAMEEK DAVONE (DC)
Entity type:Individual
Prefix:DR
First Name:SHAMEEK
Middle Name:DAVONE
Last Name:MOSBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 BEACH 61ST ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1856
Mailing Address - Country:US
Mailing Address - Phone:347-409-4969
Mailing Address - Fax:
Practice Address - Street 1:44 E 32ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5557
Practice Address - Country:US
Practice Address - Phone:212-596-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor