Provider Demographics
NPI:1306407580
Name:SHAH, SYED YOUSAF ALI (MD)
Entity Type:Individual
Prefix:
First Name:SYED YOUSAF ALI
Middle Name:
Last Name:SHAH
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 1:2020 INDIAN RIDGE RD APT 103
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4284
Mailing Address - Country:US
Mailing Address - Phone:423-767-1204
Mailing Address - Fax:
Practice Address - Street 1:JOHNSON CITY MEDICAL CENTER
Practice Address - Street 2:400 N STATE OF FRANKLIN RD,
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-431-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program