Healthcare Provider Details

I. General information

NPI: 1205834942
Provider Name (Legal Business Name): SHABIR BHAYANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 INTERSTATE PKWY STE 32
BRADFORD PA
16701
US

IV. Provider business mailing address

116 INTERSTATE PKWY STE 32
BRADFORD PA
16701-1036
US

V. Phone/Fax

Practice location:
  • Phone: 814-368-1020
  • Fax: 814-368-1024
Mailing address:
  • Phone: 814-368-1020
  • Fax: 814-368-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD038317E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1728801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: