Healthcare Provider Details

I. General information

NPI: 1144271784
Provider Name (Legal Business Name): SAIRA KHALID SHAHAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. SAIRA KHALID

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE SUITE # 18
HEMPSTEAD NY
11550-8115
US

IV. Provider business mailing address

332 BRYN MAWR RD
NEW HYDE PARK NY
11040-3509
US

V. Phone/Fax

Practice location:
  • Phone: 516-565-5200
  • Fax: 516-565-6215
Mailing address:
  • Phone: 516-746-5239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number230853-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: