Provider Demographics
NPI:1285154419
Name:MALIK, SHEHRYAR AHMED (DO)
Entity type:Individual
Prefix:
First Name:SHEHRYAR
Middle Name:AHMED
Last Name:MALIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NICOLLS RD # 16-030
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-8478
Mailing Address - Fax:631-444-7546
Practice Address - Street 1:100 NICOLLS RD # T16-030
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-9612
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:631-444-7546
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY331761207Q00000X
MO2018030876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine