Healthcare Provider Details

I. General information

NPI: 1316314636
Provider Name (Legal Business Name): ABDUL SHAHIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

3720 90TH ST APT 2A
JACKSON HEIGHTS NY
11372-7881
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 347-741-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: