Healthcare Provider Details

I. General information

NPI: 1851736466
Provider Name (Legal Business Name): SHAHID ALI NP PSYCHIATRY AND FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 BUFFALO RD
NORTH CHILI NY
14514-1206
US

IV. Provider business mailing address

4370 BUFFALO RD
NORTH CHILI NY
14514-1206
US

V. Phone/Fax

Practice location:
  • Phone: 585-683-8515
  • Fax:
Mailing address:
  • Phone: 585-683-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number333755
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number400972
License Number StateNY

VIII. Authorized Official

Name: SHAHID ALI
Title or Position: OWNER
Credential: NP, NPP
Phone: 585-683-8515