Healthcare Provider Details

I. General information

NPI: 1275715153
Provider Name (Legal Business Name): SHAKEEL AHMAD USMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

1869 CROPSEY AVE #2R
BROOKLYN NY
11214-6040
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0437
  • Fax:
Mailing address:
  • Phone: 718-373-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number246844
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: