Healthcare Provider Details

I. General information

NPI: 1104986033
Provider Name (Legal Business Name): SHAHANA PERVEEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

204 BIRCH DR
MANHASSET HILLS NY
11040-2322
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6205
  • Fax: 212-534-7831
Mailing address:
  • Phone: 516-414-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number001464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: