MEDICARE: SUHAIL SHAH MD PC

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	207R00000X	Internal Medicine Physician	206932	NY

General Provider Information

NPI Number	:	1730251810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUHAIL SHAH MD PC

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-0441
Country	:	US
Telephone Number	:	516-292-6642
Fax Number	:	516-292-2558

Provider Business Practice Location Address
First Line	:	1483 BEECH LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3706
Country	:	US
Telephone Number	:	516-292-6642
Fax Number	:	516-292-2558

Authorized Official
Title or Position	:	CEO
Name	:	DR. SUHAIL A SHAH
Credential	:	MD
Telephone Number	:	516-292-6642

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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