Healthcare Provider Details

I. General information

NPI: 1639853898
Provider Name (Legal Business Name): WASIF NAUMAN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/04/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PLACE 4TH FLOOR, RESIDENCY SUITE
POUGHKEEPSIE NY
12601
US

IV. Provider business mailing address

45 READE PLACE 4TH FLOOR, RESIDENCY SUITE
POUGHKEEPSIE NY
12601
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-1314
  • Fax:
Mailing address:
  • Phone: 845-790-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: