Provider Demographics
NPI:1114313293
Name:CHOWDHURY-BRITTO, SHABANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:
Last Name:CHOWDHURY-BRITTO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SHABANA
Other - Middle Name:
Other - Last Name:CHOWDHURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:181 MAIN ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-427-3678
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:SUITE #207
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-427-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000000213ES0103X
NY006918213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty