Healthcare Provider Details

I. General information

NPI: 1245114016
Provider Name (Legal Business Name): ADEL SHAHNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

311 E 54TH ST APT 4E
NEW YORK NY
10022-5085
US

V. Phone/Fax

Practice location:
  • Phone: 347-798-9213
  • Fax:
Mailing address:
  • Phone: 347-514-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number60-P136564-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: