Provider Demographics
NPI:1144518911
Name:SCHIEFELBEIN, COURTNEY AUDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:AUDRA
Last Name:SCHIEFELBEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:AUDRA
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:212 W 18TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4554
Mailing Address - Country:US
Mailing Address - Phone:708-307-3822
Mailing Address - Fax:
Practice Address - Street 1:76 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8724
Practice Address - Country:US
Practice Address - Phone:646-770-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0573101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty