Provider Demographics
NPI:1508953779
Name:IFTIKHAR, SHAHEDA AHMED (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:AHMED
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PHEASANT RUN LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8142
Mailing Address - Country:US
Mailing Address - Phone:631-853-3012
Mailing Address - Fax:
Practice Address - Street 1:225 RABRO DRIVE EAST
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4290
Practice Address - Country:US
Practice Address - Phone:631-853-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190090207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842199Medicare ID - Type Unspecified
NYG99265Medicare UPIN
NY796571Medicare ID - Type Unspecified