Healthcare Provider Details

I. General information

NPI: 1467770636
Provider Name (Legal Business Name): SUMERA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST NIAGARA FALLS MEMORIAL MEDICAL CENTER
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

PO BOX 1708
AMHERST NY
14226-7708
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number256681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: