Provider Demographics
NPI:1144953506
Name:SHYKOTA, ANDRII (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDRII
Middle Name:
Last Name:SHYKOTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 BEAUHARNOIS ST.
Mailing Address - Street 2:
Mailing Address - City:LONGUEUIL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J4M 1X3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 PARK ST STE 2
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1251
Practice Address - Country:US
Practice Address - Phone:518-481-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist