Provider Demographics
NPI:1205834942
Name:BHAYANI, SHABIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABIR
Middle Name:
Last Name:BHAYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 INTERSTATE PKWY STE 32
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1036
Mailing Address - Country:US
Mailing Address - Phone:814-368-1020
Mailing Address - Fax:814-368-1024
Practice Address - Street 1:116 INTERSTATE PKWY STE 32
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-368-1020
Practice Address - Fax:814-368-1024
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038317E207X00000X
NY1728801207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010983320003Medicaid
NY200209173OtherRAILROAD MEDICARE
NY01123862Medicaid
PA200007157OtherRAILROAD MEDICARE
NY01123862Medicaid