Healthcare Provider Details

I. General information

NPI: 1477575546
Provider Name (Legal Business Name): NAVEED HUSSAIN SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND DR
COVENTRY RI
02816-6716
US

IV. Provider business mailing address

PO BOX 7411009
CHICAGO IL
60674-3009
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 872-231-3162
  • Fax: 312-635-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberD0064789
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0064789
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0064789
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD21195
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: