MEDICARE: SHAHID NAWAZ 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	207RH0003X	Hematology & Oncology Physician	200023	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	:	1700880465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHID NAWAZ MD

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 BLDG 4
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	315-096-5596

Provider Business Practice Location Address
First Line	:	285 SILLS RD BLDG 16
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-4808
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/31/2020

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