Provider Demographics
NPI:1043286602
Name:AHMAD, SHAKEEL
Entity Type:Individual
Prefix:
First Name:SHAKEEL
Middle Name:
Last Name:AHMAD
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 1:12 CENTER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2514
Practice Address - Country:US
Practice Address - Phone:716-672-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221553207R00000X
NY221553-012083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227269Medicaid
NYJ400108685Medicare PIN
NYCC9803Medicare ID - Type Unspecified
NYH52583Medicare UPIN