MEDICARE: DR. SANJIDA SHOMA CABOT M.D., PH.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
1	208D00000X	General Practice Physician	278027	NY

General Provider Information

NPI Number	:	1548522493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJIDA SHOMA CABOT M.D., PH.D.

Provider Business Mailing Address
First Line	:	408 SADDLE COVE RD
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-2679
Country	:	US
Telephone Number	:	631-563-1844
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 ROCKAWAY TPKE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1122
Country	:	US
Telephone Number	:	516-858-4323
Fax Number	:	516-400-4323

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

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	01/26/2017

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