Provider Demographics
NPI:1386805505
Name:TEPPER, SHELLEY L (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:L
Last Name:TEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2735
Mailing Address - Country:US
Mailing Address - Phone:631-361-4000
Mailing Address - Fax:631-361-4037
Practice Address - Street 1:45 MANOR RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2735
Practice Address - Country:US
Practice Address - Phone:631-361-4000
Practice Address - Fax:631-361-4037
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154666207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology