Healthcare Provider Details

I. General information

NPI: 1417691130
Provider Name (Legal Business Name): SHAWON AHMED PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

1000 10TH AVE
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-0000
  • Fax:
Mailing address:
  • Phone: 212-523-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: