Healthcare Provider Details

I. General information

NPI: 1316369481
Provider Name (Legal Business Name): SHAFAQ BUKHARI II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13411 KEW GARDENS RD
RICHMOND HILL NY
11418-1930
US

IV. Provider business mailing address

13411 KEW GARDENS RD
RICHMOND HILL NY
11418-1930
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-0155
  • Fax: 718-850-7420
Mailing address:
  • Phone: 718-441-0155
  • Fax: 718-850-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: