Healthcare Provider Details

I. General information

NPI: 1972249209
Provider Name (Legal Business Name): SHAH HUZAIFA FEROZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34881 GLEN DR
EASTLAKE OH
44095-2620
US

IV. Provider business mailing address

34881 GLEN DR
EASTLAKE OH
44095-2620
US

V. Phone/Fax

Practice location:
  • Phone: 203-909-4838
  • Fax:
Mailing address:
  • Phone: 203-909-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35.152480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: