Provider Demographics
NPI:1528149952
Name:SHASHOU, DOVELET T (MD)
Entity type:Individual
Prefix:
First Name:DOVELET
Middle Name:T
Last Name:SHASHOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173A 2ND AVE
Mailing Address - Street 2:#296
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8277
Mailing Address - Country:US
Mailing Address - Phone:718-920-5439
Mailing Address - Fax:
Practice Address - Street 1:MMC - DEPT. OF OPHTHALMOLOGY
Practice Address - Street 2:111 E.210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-920-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162814207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology