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General NPI Number Information
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NPI Number | 1427329671
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Entity Type | Individual
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Provider Name | SHAHID ILYAS M.D
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 8268 164TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-1121
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Country | US
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Telephone | 718-883-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 14341 84TH DR APT 4E
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City | BRIARWOOD
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State | NY
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Zip | 11435-2205
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Country | US
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Telephone | 347-302-3994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101256200
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License Number State | VA
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