Healthcare Provider Details

I. General information

NPI: 1811140932
Provider Name (Legal Business Name): SHAHEED KHAN M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 SPRINGFIELD BLVD
SPRINGFIELD GARDENS NY
11413-1448
US

IV. Provider business mailing address

13421 SPRINGFIELD BLVD
SPRINGFIELD GARDENS NY
11413-1448
US

V. Phone/Fax

Practice location:
  • Phone: 718-528-6377
  • Fax: 718-949-4580
Mailing address:
  • Phone: 718-528-6377
  • Fax: 718-949-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number170541
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number169313
License Number StateNY

VIII. Authorized Official

Name: MRS. MARIA OROZCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-766-8995