Healthcare Provider Details

I. General information

NPI: 1518876465
Provider Name (Legal Business Name): KAHAAN SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN ST STE B
JOHNSON CITY NY
13790-2050
US

IV. Provider business mailing address

100 ALBERT ST APT 124
JOHNSON CITY NY
13790-1960
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6775
  • Fax:
Mailing address:
  • Phone: 607-416-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20-P105519-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: