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NPI Code Detail

MEDICARE: DR. SHAFI WANI M.D.

MEDICARE: DR. SHAFI WANI M.D.
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
1174400000XSpecialist111748NY

General Provider Information

NPI Number : 1114920436
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAFI WANI M.D.
Provider Business Mailing Address
First Line : 2500 NESCONSET HWY
Second Line : BLDG 15H
City : STONY BROOK
State : NY
Zip : 11790-2554
Country : US
Telephone Number : 631-689-3005
Fax Number : 631-689-1750
Provider Business Practice Location Address
First Line : 2500 NESCONSET HWY
Second Line : BLDG 15H
City : STONY BROOK
State : NY
Zip : 11790-2554
Country : US
Telephone Number : 631-689-3005
Fax Number : 631-689-1750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 02/03/2015

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