MEDICARE: SAAD A. SHUKRI, M.D, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		NY

General Provider Information

NPI Number	:	1033260609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAAD A. SHUKRI, M.D, PC

Provider Business Mailing Address
First Line	:	286 SILLS RD STE 3
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8810
Country	:	US
Telephone Number	:	631-447-8697
Fax Number	:	631-447-0913

Provider Business Practice Location Address
First Line	:	286 SILLS RD STE 3
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8810
Country	:	US
Telephone Number	:	631-447-8697
Fax Number	:	631-447-0913

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSAN SHUKRI
Credential	:
Telephone Number	:	631-447-8697

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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