=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487510814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHADY MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5015 CAMPUSWOOD DR STE 207
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-429-8590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5015 CAMPUSWOOD DR STE 207
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-429-8590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMR SHADY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 607-429-8590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------