Provider Demographics
NPI:1093401531
Name:BHUIYAN, MD SHADATH H (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:
First Name:MD SHADATH
Middle Name:H
Last Name:BHUIYAN
Suffix:
Gender:M
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9752 75TH ST APT A26
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1097
Mailing Address - Country:US
Mailing Address - Phone:929-393-0686
Mailing Address - Fax:
Practice Address - Street 1:1226 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3433
Practice Address - Country:US
Practice Address - Phone:929-393-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide