MEDICARE: SHAMA RASOOL MD

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	2084P0800X	Psychiatry Physician	159418	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588678718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMA RASOOL MD

Provider Business Mailing Address
First Line	:	7603 113TH STREET
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6585
Country	:	US
Telephone Number	:	718-268-1100
Fax Number	:	718-263-6418

Provider Business Practice Location Address
First Line	:	7603 113TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6585
Country	:	US
Telephone Number	:	718-268-1100
Fax Number	:	718-263-6418

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/24/2008

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