Healthcare Provider Details

I. General information

NPI: 1710631817
Provider Name (Legal Business Name): ASHMA SHAHID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 BELL BLVD
BAYSIDE NY
11361-2865
US

IV. Provider business mailing address

4320 BELL BLVD
BAYSIDE NY
11361-2865
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-8200
  • Fax:
Mailing address:
  • Phone: 718-631-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: