Provider Demographics
NPI:1346267218
Name:JHAMB, SHASHI B (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:B
Last Name:JHAMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHASHI
Other - Middle Name:BALA
Other - Last Name:JHAMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:375 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3521
Mailing Address - Country:US
Mailing Address - Phone:631-277-0591
Mailing Address - Fax:631-859-0092
Practice Address - Street 1:375 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3521
Practice Address - Country:US
Practice Address - Phone:631-277-0591
Practice Address - Fax:631-859-0052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00806299Medicaid
NY00806299Medicaid
NY06D501Medicare PIN