Healthcare Provider Details

I. General information

NPI: 1518271154
Provider Name (Legal Business Name): SHAMSUDDIN SHAIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 S CEDAR CREST BLVD STE 2800
ALLENTOWN PA
18103-6230
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-6790
  • Fax: 610-402-6979
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD449297
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: