Provider Demographics
NPI:1235169285
Name:RAHMAN, SHAHEEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:B
Last Name:RAHMAN
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 1:23 KNOX CAVE RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-2800
Mailing Address - Country:US
Mailing Address - Phone:518-872-2795
Mailing Address - Fax:
Practice Address - Street 1:2200 ROSA RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-3717
Practice Address - Country:US
Practice Address - Phone:518-374-3341
Practice Address - Fax:518-374-2329
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01754058Medicaid
NEG52894Medicare UPIN
NY01754058Medicaid