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General NPI Number Information
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NPI Number | 1689315962
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Entity Type | Individual
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Provider Name | MD TAMHID SHADMAN FNP
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Gender | Male
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Dates
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Enumeration Date | 04/02/2022
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 4023 74TH ST
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City | ELMHURST
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State | NY
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Zip | 11373-5603
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Country | US
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Telephone | 718-424-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 16351 MATHIAS AVE
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City | JAMAICA
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State | NY
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Zip | 11433-3926
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Country | US
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Telephone | 646-966-9477
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F353311
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 829887
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License Number State | NY
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