Healthcare Provider Details

I. General information

NPI: 1326080201
Provider Name (Legal Business Name): SHAHID SHEIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WEST SUNRISE HIGHWAY SUITE 200
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

1000 ZECKENDORF BLVD
GARDEN CITY NY
11530-2133
US

V. Phone/Fax

Practice location:
  • Phone: 516-825-3600
  • Fax: 516-823-2051
Mailing address:
  • Phone: 516-542-6880
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number173425
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01107762
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: