Provider Demographics
NPI:1316912041
Name:SHAUKAT, KAMRAN (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:SHAUKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2026
Mailing Address - Country:US
Mailing Address - Phone:914-664-8000
Mailing Address - Fax:914-664-8015
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2917
Practice Address - Country:US
Practice Address - Phone:631-812-2873
Practice Address - Fax:917-979-4997
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1789072086S0105X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01197653Medicaid
E71607Medicare UPIN
NY60F421Medicare PIN