Healthcare Provider Details

I. General information

NPI: 1275437162
Provider Name (Legal Business Name): SHAWON AHMED PHYSICIAN ASSISTANT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 29TH ST APT 4L
ASTORIA NY
11106-3247
US

IV. Provider business mailing address

3608 29TH ST APT 4L
ASTORIA NY
11106-3247
US

V. Phone/Fax

Practice location:
  • Phone: 917-607-7091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWON AHMED
Title or Position: PHYSICIAN ASSISTANT/OWNER
Credential: PA
Phone: 917-607-7091