Provider Demographics
NPI:1427066414
Name:KHAN, SHAHEED (MD)
Entity type:Individual
Prefix:
First Name:SHAHEED
Middle Name:
Last Name:KHAN
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 1:134-21 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413
Mailing Address - Country:US
Mailing Address - Phone:718-528-6377
Mailing Address - Fax:718-949-4580
Practice Address - Street 1:134-21 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413
Practice Address - Country:US
Practice Address - Phone:718-528-6377
Practice Address - Fax:718-949-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01022095Medicaid
NY01022095Medicaid
NYB58787Medicare UPIN