Provider Demographics
NPI:1144451899
Name:RAMETRA, SHAIFALI (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAIFALI
Middle Name:
Last Name:RAMETRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CUBA HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4805
Mailing Address - Country:US
Mailing Address - Phone:631-889-9975
Mailing Address - Fax:
Practice Address - Street 1:1679 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2406
Practice Address - Country:US
Practice Address - Phone:631-771-1577
Practice Address - Fax:631-771-1570
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100611223G0001X
NY0544751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03157260Medicaid