Provider Demographics
NPI:1376573733
Name:ALI, SHAHID S (NPP, FNP)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:NPP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 BROMLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9784
Mailing Address - Country:US
Mailing Address - Phone:585-683-8515
Mailing Address - Fax:
Practice Address - Street 1:451 BROMLEY RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9784
Practice Address - Country:US
Practice Address - Phone:585-683-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333755363LF0000X
NY400972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP0699OtherPREFERED CARE ROCHESTER N
NYNP0699OtherPREFERED CARE ROCHESTER N
NYDD5531Medicare ID - Type Unspecified