Provider Demographics
NPI:1235255456
Name:SHIKARA, MAAN MUHAMMED ALI (MD)
Entity Type:Individual
Prefix:
First Name:MAAN
Middle Name:MUHAMMED ALI
Last Name:SHIKARA
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 1:48 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6924
Mailing Address - Country:US
Mailing Address - Phone:631-206-2901
Mailing Address - Fax:
Practice Address - Street 1:48 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6924
Practice Address - Country:US
Practice Address - Phone:631-206-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02470693Medicaid
NY02470693Medicaid
NYH64298Medicare UPIN