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NPI Code Detail

MEDICARE: DR. SHIVA SHAMTOUB DO

MEDICARE:  DR. SHIVA  SHAMTOUB  DO
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
1207R00000XInternal Medicine Physician241306NY

General Provider Information

NPI Number : 1366586646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHIVA SHAMTOUB DO
Provider Business Mailing Address
First Line : 14712 ROCKAWAY BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11436-1634
Country : US
Telephone Number : 718-732-7744
Fax Number : 347-644-1745
Provider Business Practice Location Address
First Line : 14712 ROCKAWAY BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11436-1634
Country : US
Telephone Number : 718-732-7744
Fax Number : 347-644-1745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 06/25/2014

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Directions to “ DR. SHIVA SHAMTOUB DO” Practice Location

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