Provider Demographics
NPI:1588760235
Name:SHEFLIN, CRAIG LOUISE (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:LOUISE
Last Name:SHEFLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MUNRO BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3304
Mailing Address - Country:US
Mailing Address - Phone:516-791-5800
Mailing Address - Fax:516-837-3999
Practice Address - Street 1:15 MUNRO BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3304
Practice Address - Country:US
Practice Address - Phone:516-791-5800
Practice Address - Fax:516-837-3999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04945Medicare ID - Type UnspecifiedQUEENS
NYH54683Medicare UPIN
NY5087B2Medicare ID - Type UnspecifiedNASSAU