Provider Demographics
NPI:1962889618
Name:PAHWA, SHEBANI
Entity type:Individual
Prefix:
First Name:SHEBANI
Middle Name:
Last Name:PAHWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 5TH AVE APT 37F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2537
Mailing Address - Country:US
Mailing Address - Phone:301-910-3100
Mailing Address - Fax:
Practice Address - Street 1:111 E 57TH ST # 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2009
Practice Address - Country:US
Practice Address - Phone:301-910-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16163122300000X
DCDEN1001562122300000X
NY060299-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962889618OtherNONE