Provider Demographics
NPI:1699110569
Name:SHAHID, NADEEM
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:SHAHID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2680
Mailing Address - Country:US
Mailing Address - Phone:914-863-0056
Mailing Address - Fax:
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:STE 306
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2680
Practice Address - Country:US
Practice Address - Phone:914-863-0056
Practice Address - Fax:914-863-0146
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine