Provider Demographics
NPI:1033679055
Name:SHEIKH, MOHAMMAD AMANULLAH
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AMANULLAH
Last Name:SHEIKH
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 1:8942 202ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2202
Mailing Address - Country:US
Mailing Address - Phone:631-552-6179
Mailing Address - Fax:516-441-6788
Practice Address - Street 1:6136 170TH ST APT M4
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1957
Practice Address - Country:US
Practice Address - Phone:646-372-0870
Practice Address - Fax:516-441-6788
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100024-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine