Healthcare Provider Details

I. General information

NPI: 1417889874
Provider Name (Legal Business Name): NIHA SHAHZAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 COLUMBIA TPKE
CASTLETON NY
12033-9535
US

IV. Provider business mailing address

1645 COLUMBIA TPKE
CASTLETON NY
12033-9535
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-8166
  • Fax:
Mailing address:
  • Phone: 518-477-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: