Provider Demographics
NPI:1376558148
Name:SHAHMALAK, SHAHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:
Last Name:SHAHMALAK
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 1:1814 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1229
Mailing Address - Country:US
Mailing Address - Phone:606-242-2519
Mailing Address - Fax:606-242-2520
Practice Address - Street 1:1814 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1229
Practice Address - Country:US
Practice Address - Phone:606-242-2519
Practice Address - Fax:606-242-2520
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY370872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH64878Medicare UPIN