MEDICARE: KEYUR N SHAH B.S.

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	183500000X	Pharmacist	000121	NY

General Provider Information

NPI Number	:	1093875064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYUR N SHAH B.S.

Provider Business Mailing Address
First Line	:	23040 88TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2608
Country	:	US
Telephone Number	:	516-784-6886
Fax Number	:

Provider Business Practice Location Address
First Line	:	16502 BAISLEY BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-2517
Country	:	US
Telephone Number	:	718-525-7642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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