MEDICARE: EUIBEOM SHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	103934I	NY

General Provider Information

NPI Number	:	1477497360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUIBEOM SHIN

Provider Business Mailing Address
First Line	:	206 AFFINITY LN APT C
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-2523
Country	:	US
Telephone Number	:	518-687-4796
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 AFFINITY LN APT C
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-2523
Country	:	US
Telephone Number	:	518-687-4796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ EUIBEOM SHIN ” Practice Location

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