Provider Demographics
NPI:1104986033
Name:PERVEEN, SHAHANA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHANA
Middle Name:
Last Name:PERVEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2322
Mailing Address - Country:US
Mailing Address - Phone:516-414-1962
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6205
Practice Address - Fax:212-534-7831
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0014642080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine