MEDICARE: SHAHED KHANDAKAR

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	062671-1	NY

General Provider Information

NPI Number	:	1518408327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHED KHANDAKAR

Provider Business Mailing Address
First Line	:	2648 FLOWER ST
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590-5604
Country	:	US
Telephone Number	:	516-474-4504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2455
Country	:	US
Telephone Number	:	718-239-7900
Fax Number	:

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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Directions to “ SHAHED KHANDAKAR ” Practice Location

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