Healthcare Provider Details

I. General information

NPI: 1902251010
Provider Name (Legal Business Name): SHOAIB JUNEJO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 W FAIDLEY AVE
GRAND ISLAND NE
68803-4205
US

IV. Provider business mailing address

8268 164TH ST
JAMAICA NY
11432-1121
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-8919
  • Fax:
Mailing address:
  • Phone: 718-883-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31063
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: